Provider Demographics
NPI:1144612375
Name:TAYLOR, NAOMI DIANA (LICENSED PRACTICAL N)
Entity Type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:DIANA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19940 CONANT
Mailing Address - Street 2:STE. A, B & C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1494
Mailing Address - Country:US
Mailing Address - Phone:313-305-4180
Mailing Address - Fax:313-733-8190
Practice Address - Street 1:19940 CONANT
Practice Address - Street 2:STE. A, B & C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1494
Practice Address - Country:US
Practice Address - Phone:313-305-4180
Practice Address - Fax:313-733-8190
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703093935164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse