Healthcare Provider Details

I. General information

NPI: 1013659754
Provider Name (Legal Business Name): TAYLOR ALYSE JAMERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 DIVISADERO ST
SAN FRANCISCO CA
94115-3011
US

IV. Provider business mailing address

1050 WALL ST APT 2D
ANN ARBOR MI
48105-1936
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: