Healthcare Provider Details

I. General information

NPI: 1235953217
Provider Name (Legal Business Name): TAYLOR LYNN RELLER MLS(ASCP)CM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR LYNN NORBY

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

7152 41ST ST N
MOORHEAD MN
56560-7011
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3241
  • Fax:
Mailing address:
  • Phone: 320-295-0254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: