Provider Demographics
NPI:1588866560
Name:TAYLOR, LA TONYA RENEE (CNA1)
Entity type:Individual
Prefix:MS
First Name:LA TONYA
Middle Name:RENEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CNA1
Other - Prefix:MS
Other - First Name:LA TONYA
Other - Middle Name:RENEE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA2
Mailing Address - Street 1:125 PEGG AVE
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-2433
Mailing Address - Country:US
Mailing Address - Phone:336-995-7816
Mailing Address - Fax:336-996-2594
Practice Address - Street 1:125 PEGG AVE
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2433
Practice Address - Country:US
Practice Address - Phone:336-995-7816
Practice Address - Fax:336-996-2594
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55183376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide