Provider Demographics
NPI:1487336764
Name:MOORE, TAYLOR CAITLIN (COMMUNITY HEALTH WOR)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CAITLIN
Last Name:MOORE
Suffix:
Gender:F
Credentials:COMMUNITY HEALTH WOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 3RD AVE SW APT 1
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1552
Mailing Address - Country:US
Mailing Address - Phone:605-310-3991
Mailing Address - Fax:
Practice Address - Street 1:611 3RD AVE SW APT 1
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1552
Practice Address - Country:US
Practice Address - Phone:160-531-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker