Healthcare Provider Details

I. General information

NPI: 1750341442
Provider Name (Legal Business Name): NANCY JUNE TAYLOR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 HORTON RD SUITE A
JACKSON MI
49203-5260
US

IV. Provider business mailing address

1331 HORTON RD SUITE A
JACKSON MI
49203-5260
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-4242
  • Fax: 517-784-6943
Mailing address:
  • Phone: 517-784-4242
  • Fax: 517-784-6943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101013880
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: