Provider Demographics
NPI:1053526269
Name:TAYLOR, LOIS JANE (CANP)
Entity type:Individual
Prefix:MS
First Name:LOIS
Middle Name:JANE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CANP
Other - Prefix:MS
Other - First Name:LOIS
Other - Middle Name:JANE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNP
Mailing Address - Street 1:3400 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-2295
Mailing Address - Country:US
Mailing Address - Phone:574-722-9366
Mailing Address - Fax:574-722-5987
Practice Address - Street 1:3400 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-2295
Practice Address - Country:US
Practice Address - Phone:574-722-9366
Practice Address - Fax:574-722-5987
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001445A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200860400Medicaid
INP00409786OtherRAILROAD
IN000000548096OtherBLUE CROSS
INP00409786OtherRAILROAD
Q48046Medicare UPIN
IN200860400Medicaid