Provider Demographics
NPI:1578143897
Name:TAYLOR, RYAN DENNIS (RN)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DENNIS
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6122 S IVANHOE AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9707
Mailing Address - Country:US
Mailing Address - Phone:313-909-7531
Mailing Address - Fax:
Practice Address - Street 1:753 S GROVE ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6304
Practice Address - Country:US
Practice Address - Phone:734-482-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-11
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704365483163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse