Provider Demographics
NPI:1023682523
Name:WILSON, TAYLOR ABIGAIL (CNA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ABIGAIL
Last Name:WILSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 ELM ST APT E
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-1267
Mailing Address - Country:US
Mailing Address - Phone:907-328-9066
Mailing Address - Fax:
Practice Address - Street 1:307 E NORTHERN LIGHTS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2701
Practice Address - Country:US
Practice Address - Phone:907-865-3247
Practice Address - Fax:833-992-2022
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNUAA14750376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide