Provider Demographics
NPI:1588059687
Name:TAYLOR, CHARLEA
Entity type:Individual
Prefix:
First Name:CHARLEA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5855
Mailing Address - Country:US
Mailing Address - Phone:304-485-6513
Mailing Address - Fax:
Practice Address - Street 1:7412 PARKERSBURG RD
Practice Address - Street 2:
Practice Address - City:SANDYVILLE
Practice Address - State:WV
Practice Address - Zip Code:25275-7508
Practice Address - Country:US
Practice Address - Phone:304-273-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV82460163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse