Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1144749128 |
---|---|
Provider Name | Mrs. Laura Elizabeth Taylor |
First Address | Memphis, MI 48041 |
Second Address | Port Huron, MI 48041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2017 |
Last Update Date | 11/09/2017 |