Healthcare Provider Details

I. General information

NPI: 1821815168
Provider Name (Legal Business Name): TAYLOR LANE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 E BIG BEAVER RD
TROY MI
48083-2053
US

IV. Provider business mailing address

1639 E BIG BEAVER RD STE 201
TROY MI
48083-2054
US

V. Phone/Fax

Practice location:
  • Phone: 248-528-9000
  • Fax:
Mailing address:
  • Phone: 248-528-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704359017
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: