Healthcare Provider Details

I. General information

NPI: 1760405310
Provider Name (Legal Business Name): MICHELLE DIONE TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NE 139TH STREET MOB B SUITE 260
VANCOUVER WA
98686-2742
US

IV. Provider business mailing address

2101 NE 139TH ST #260
VANCOUVER WA
98686-2309
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-2810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00046752
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: