Healthcare Provider Details

I. General information

NPI: 1467245340
Provider Name (Legal Business Name): MARQUISE TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 SE HOGAN RD APT 25
GRESHAM OR
97080-8108
US

IV. Provider business mailing address

755 SE HOGAN RD APT 25
GRESHAM OR
97080-8108
US

V. Phone/Fax

Practice location:
  • Phone: 971-901-6982
  • Fax:
Mailing address:
  • Phone: 971-901-6982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: