Provider Demographics
NPI:1699940189
Name:TAYLOR, NAN R (CCC-A)
Entity type:Individual
Prefix:
First Name:NAN
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 JOHNS HOPKINS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7222
Mailing Address - Country:US
Mailing Address - Phone:252-752-5227
Mailing Address - Fax:252-752-1191
Practice Address - Street 1:850 JOHNS HOPKINS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7222
Practice Address - Country:US
Practice Address - Phone:252-752-5227
Practice Address - Fax:252-752-1191
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC160231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist