Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 0024176944 | VA |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 202007158NP-PP | OR |
NPI | 1083156277 |
---|---|
Provider Name | Ms. Kristi A Taylor |
First Address | Portland, OR 97208-3158 |
Second Address | Medford, OR 97504-5590 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2016 |
Last Update Date | 29/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500784776 | (05) | OH |