Provider Demographics
NPI:1699728048
Name:TAYLOR, LORRAINE SULLIVAN (APRN)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:SULLIVAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-4200
Mailing Address - Country:US
Mailing Address - Phone:860-345-3322
Mailing Address - Fax:
Practice Address - Street 1:39 BROOKLINE AVE.
Practice Address - Street 2:
Practice Address - City:HIGGANUM
Practice Address - State:CT
Practice Address - Zip Code:06441
Practice Address - Country:US
Practice Address - Phone:860-345-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000614363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner