Healthcare Provider Details

I. General information

NPI: 1285359976
Provider Name (Legal Business Name): TAYLOR ANNE WOLOSZYK BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6549 TOWN CENTER DR STE A
CLARKSTON MI
48346-4824
US

IV. Provider business mailing address

6549 TOWN CENTER DR STE A
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 248-620-6400
  • Fax:
Mailing address:
  • Phone: 248-620-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704366169
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704366169
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: