Basic Information
| Provider Information | |||||||||
| NPI: | 1093854572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | THERESE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 717 STATE STREET, | ||||||||
| Address2: | SUITE 16 LL REGIONAL HEALTH SERVICES, INC | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165011360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144807100 | ||||||||
| FaxNumber: | 8144807604 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 EAST 2ND STREET | ||||||||
| Address2: | HAMOT BARIATRIC SURGERY CENTER | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148776997 | ||||||||
| FaxNumber: | 8148776356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 03/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0200X | RN502657L | PA | N | Nursing Service Providers | Registered Nurse | Oncology | 163WX0200X | TP007043B | PA | Y | Nursing Service Providers | Registered Nurse | Oncology |
No ID Information.