Basic Information
| Provider Information | |||||||||
| NPI: | 1023338233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | ANRP, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 NE MATSON ST | ||||||||
| Address2: | |||||||||
| City: | POULSBO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983708461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606263601 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 22180 OLYMPIC COLLEGE WAY NW | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | POULSBO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983706664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607794444 | ||||||||
| FaxNumber: | 3606972514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2010 | ||||||||
| LastUpdateDate: | 01/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201050082NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AP60281164 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.