Provider Demographics
NPI:1174131007
Name:TAYLOR, BRENDA SUE (RN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:SUE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:500 AMALFI LOOP APT 216
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-8021
Mailing Address - Country:US
Mailing Address - Phone:513-284-0331
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.186081163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy