Healthcare Provider Details

I. General information

NPI: 1861927295
Provider Name (Legal Business Name): TAYLOR LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR BRAZELTON

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TWP MI
48038-3504
US

IV. Provider business mailing address

15855 19 MILE RD
CLINTON TWP MI
48038-3504
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-2969
  • Fax: 586-203-5296
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4704279427
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: