Provider Demographics
NPI:1609609114
Name:REBECCA R TAYLOR
Entity type:Organization
Organization Name:REBECCA R TAYLOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:812-269-7377
Mailing Address - Street 1:3105 S SARE RD STE 102B
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-0052
Mailing Address - Country:US
Mailing Address - Phone:812-269-7377
Mailing Address - Fax:
Practice Address - Street 1:3105 S SARE RD STE 102B
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-0052
Practice Address - Country:US
Practice Address - Phone:812-269-7377
Practice Address - Fax:888-554-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty