Provider Demographics
NPI:1376075515
Name:TAYLOR, VANESSA (FNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 S MAUTE RD
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-9744
Mailing Address - Country:US
Mailing Address - Phone:734-904-1803
Mailing Address - Fax:
Practice Address - Street 1:7025 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9479
Practice Address - Country:US
Practice Address - Phone:734-463-3616
Practice Address - Fax:734-463-3618
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704270677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily