MEDICARE: TAYLOR JOSWIAK

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	363A00000X	Physician Assistant	3910	WI
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1265981096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR JOSWIAK

Provider Business Mailing Address
First Line	:	212800 STAINLESS AVE
Second Line	:
City	:	STRATFORD
State	:	WI
Zip	:	54484-4325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	212800 STAINLESS AVE
Second Line	:
City	:	STRATFORD
State	:	WI
Zip	:	54484-4325
Country	:	US
Telephone Number	:	715-687-4211
Fax Number	:

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

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	10/15/2020

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