Basic Information
| Provider Information | |||||||||
| NPI: | 1407918295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | JOAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 189 | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283370189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108726251 | ||||||||
| FaxNumber: | 9108626859 | ||||||||
| Practice Location | |||||||||
| Address1: | 803 S WALKER ST | ||||||||
| Address2: | |||||||||
| City: | BURGAW | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102591207 | ||||||||
| FaxNumber: | 9102592138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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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 | 163W00000X | 133980 | NC | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 133980 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.