Provider Demographics
NPI:1508627746
Name:MIRON, TAYLOR ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ROSE
Last Name:MIRON
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:6244 HARDY AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1595
Mailing Address - Country:US
Mailing Address - Phone:708-990-4948
Mailing Address - Fax:
Practice Address - Street 1:6244 HARDY AVE APT 12
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1595
Practice Address - Country:US
Practice Address - Phone:708-990-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant