Provider Demographics
NPI:1760289946
Name:ALBUQUERQUE, TAYLOR (BSN, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:ALBUQUERQUE
Suffix:
Gender:
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 CLARKE ST
Mailing Address - Street 2:
Mailing Address - City:BEALETON
Mailing Address - State:VA
Mailing Address - Zip Code:22712-5676
Mailing Address - Country:US
Mailing Address - Phone:201-870-8621
Mailing Address - Fax:
Practice Address - Street 1:4122 CLARKE ST
Practice Address - Street 2:
Practice Address - City:BEALETON
Practice Address - State:VA
Practice Address - Zip Code:22712-5676
Practice Address - Country:US
Practice Address - Phone:201-870-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001285623163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant