Provider Demographics
NPI:1447576608
Name:TAYLOR, ROXANNE D
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 CUSTER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4356
Mailing Address - Country:US
Mailing Address - Phone:920-652-2440
Mailing Address - Fax:
Practice Address - Street 1:3415 CUSTER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4356
Practice Address - Country:US
Practice Address - Phone:920-652-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111408-30163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management