Healthcare Provider Details

I. General information

NPI: 1669592051
Provider Name (Legal Business Name): MARJORIE A TAYLOR RNC, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4069 LAKE DR SE STE 118
GRAND RAPIDS MI
49546-8816
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-8520
  • Fax:
Mailing address:
  • Phone: 616-486-6790
  • Fax: 616-486-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number4704063656
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: