MEDICARE: MS. SIERRA SKIE TAYLOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1174271514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SIERRA SKIE TAYLOR

Provider Business Mailing Address
First Line	:	1416 NELSON ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-4226
Country	:	US
Telephone Number	:	586-879-1843
Fax Number	:

Provider Business Practice Location Address
First Line	:	1416 NELSON ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-4226
Country	:	US
Telephone Number	:	586-879-1843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/16/2022

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