Basic Information
| Provider Information | |||||||||
| NPI: | 1639265275 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 MEDICAL CIRCLE | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037966811 | ||||||||
| FaxNumber: | 8037966851 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 MEDICAL CIRCLE | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037966811 | ||||||||
| FaxNumber: | 8037966851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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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 | 163WP0808X | PRV46841 | SC | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | P00038219 | 01 | SC | RR MEDICARE | OTHER |