Basic Information
| Provider Information | |||||||||
| NPI: | 1366789406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25105 NORTHRIDGE LN | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835018024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087980225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 835 SE BISHOP BLVD | ||||||||
| Address2: | |||||||||
| City: | PULLMAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991635512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093367300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2013 | ||||||||
| LastUpdateDate: | 01/09/2013 | ||||||||
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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 | RN00128050 | WA | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 0252460 | 01 | WA | LABOR & INDUSTRIES | OTHER |