Individual
TRAVIS LEE TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C, CRNFA
Contact information
Practice address
30544 HIGHWAY 200 STE 102, PONDERAY, ID 83852-5005
(208) 265-9817
Mailing address
335 S LAVINA AVE, SANDPOINT, ID 83864-1721
(208) 946-8219
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
N-37973
ID
363LF0000X
Family Nurse Practitioner
Primary
NP-1376A
ID
Other
Enumeration date
08/04/2008
Last updated
07/05/2014
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