Healthcare Provider Details

I. General information

NPI: 1548577315
Provider Name (Legal Business Name): DIANE LYNN TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAINE LYNN BEANE

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTH BLVD E SITE 390
ROCHESTER HILLS MI
48307-6122
US

IV. Provider business mailing address

60746 MIRIAM DR
WASHINGTON TWP MI
48094
US

V. Phone/Fax

Practice location:
  • Phone: 248-293-0055
  • Fax: 248-293-3338
Mailing address:
  • Phone: 586-337-4479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704219139
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704219139
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: