Provider Demographics
NPI:1114178662
Name:TAYLOR, MICHELLE P (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:P
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 W 38TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4300
Mailing Address - Country:US
Mailing Address - Phone:303-467-8987
Mailing Address - Fax:303-467-9510
Practice Address - Street 1:8550 W 38TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4300
Practice Address - Country:US
Practice Address - Phone:303-467-8987
Practice Address - Fax:303-467-9510
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2669363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical