Basic Information
| Provider Information | |||||||||
| NPI: | 1104351717 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN CDOE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 RICHMOND ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014302000 | ||||||||
| FaxNumber: | 4014537597 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 RICHMOND ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014302000 | ||||||||
| FaxNumber: | 4014537597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2017 | ||||||||
| LastUpdateDate: | 04/21/2017 | ||||||||
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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 | 163WD0400X | RN25956 | RI | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.