Healthcare Provider Details

I. General information

NPI: 1295842011
Provider Name (Legal Business Name): YVONNE M TAYLOR APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 WOODHALL ST
DETROIT MI
48224-2222
US

IV. Provider business mailing address

4303 WOODHALL ST
DETROIT MI
48224-2222
US

V. Phone/Fax

Practice location:
  • Phone: 313-671-3252
  • Fax:
Mailing address:
  • Phone: 313-671-3252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704220247
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: