Provider Demographics
NPI:1134277759
Name:TAYLOR, CHRISTINE ANNE (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANNE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:500 NE MULTNOMAH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2099
Mailing Address - Country:US
Mailing Address - Phone:180-081-3200
Mailing Address - Fax:515-248-1440
Practice Address - Street 1:412 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158
Practice Address - Country:US
Practice Address - Phone:641-753-4021
Practice Address - Fax:641-753-4025
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA001001363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS11719Medicare UPIN