Individual
MISS TAYLOR KATHRYN SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 779-3366
Mailing address
960 MASSACHUSETTS AVENUE, FL 2, BOSTON, MA 02119, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
319403
AZ
367500000X
Certified Registered Nurse Anesthetist
RN2301626
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110164287A
—
MA
05
—
3125777
—
NH
Enumeration date
07/22/2018
Last updated
02/05/2025
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