Provider Demographics
NPI:1962700625
Name:TAYLOR, KRISTINA C (RN)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:C
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:315 2ND ST.
Mailing Address - City:HAUGEN
Mailing Address - State:WI
Mailing Address - Zip Code:54841
Mailing Address - Country:US
Mailing Address - Phone:715-234-7779
Mailing Address - Fax:
Practice Address - Street 1:315 2ND ST.
Practice Address - Street 2:
Practice Address - City:HAUGEN
Practice Address - State:WI
Practice Address - Zip Code:54841
Practice Address - Country:US
Practice Address - Phone:715-234-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI172937-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health