Provider Demographics
NPI:1992405286
Name:TAYLOR-WILSON, CARLA RENEE (RN)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:RENEE
Last Name:TAYLOR-WILSON
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 1:2177 S MCQUEEN RD APT 2088
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1843
Mailing Address - Country:US
Mailing Address - Phone:773-497-9739
Mailing Address - Fax:
Practice Address - Street 1:1525 W FRYE RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6112
Practice Address - Country:US
Practice Address - Phone:480-812-7000
Practice Address - Fax:480-224-9353
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ257170163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse