Provider Demographics
NPI:1972980811
Name:TAYLOR, SIMON MAE (FNP-C)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:MAE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E PIKE ST STE 319
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3853
Mailing Address - Country:US
Mailing Address - Phone:206-880-3266
Mailing Address - Fax:
Practice Address - Street 1:911 E PIKE ST STE 319
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3853
Practice Address - Country:US
Practice Address - Phone:206-880-3266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY823936163W00000X
WARN60470931163W00000X
NY348621363LF0000X
WAAP60603282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse