Provider Demographics
NPI:1417068305
Name:TAYLOR, ARLENE CAROL (APRN BC)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:CAROL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:ARLENE
Other - Middle Name:
Other - Last Name:LOUCKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN BC
Mailing Address - Street 1:207 FLETCHER
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1050
Mailing Address - Country:US
Mailing Address - Phone:734-763-6924
Mailing Address - Fax:734-647-3071
Practice Address - Street 1:207 FLETCHER
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1050
Practice Address - Country:US
Practice Address - Phone:734-763-6924
Practice Address - Fax:734-647-3071
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704104582363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P75797Medicare UPIN