Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN429752 | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 429752 | CA |
NPI | 1013124536 |
---|---|
Provider Name | Michelle Alena Taylor |
First Address | San Luis Obispo, CA 93401 |
Second Address | San Luis Obispo, CA 93401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 15/03/2010 |