Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | APN0000011440 | TN |
NPI | 1639214869 |
---|---|
Provider Name | Mrs. Rosalyn Taylor Laster |
First Address | Humboldt, TN 38343-2879 |
Second Address | Humboldt, TN 38343-2879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |