Basic Information
| Provider Information | |||||||||
| NPI: | 1508264615 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TAYLOR | ||||||||
| FirstName: | STACIE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25938 HIGHLAND RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441432703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165330420 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7350 INDUSTRIAL PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440605318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167329480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2014 | ||||||||
| LastUpdateDate: | 06/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | COA.16509-NP | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LP2300X | COA.16509-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.