Provider Demographics
NPI:1124037148
Name:TAYLOR, SONIA DESIREE (RN, BSN, MSN)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:DESIREE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN, BSN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 FELCH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1698
Mailing Address - Country:US
Mailing Address - Phone:616-748-2850
Mailing Address - Fax:616-748-2855
Practice Address - Street 1:8333 FELCH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1698
Practice Address - Country:US
Practice Address - Phone:616-748-2850
Practice Address - Fax:616-748-2855
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704150967363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704150967OtherNURSE PRACTITIONER