Provider Demographics
NPI:1366126773
Name:NOGIEC, TAYLOR ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ELIZABETH
Last Name:NOGIEC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 N LA SALLE DR APT 407
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6007
Mailing Address - Country:US
Mailing Address - Phone:860-389-8386
Mailing Address - Fax:
Practice Address - Street 1:830 W DIVERSEY PKWY STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-8489
Practice Address - Country:US
Practice Address - Phone:732-484-1507
Practice Address - Fax:773-248-4291
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085009837363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant