Provider Demographics
NPI:1578838850
Name:TAYLOR, MICHELE M (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:M
Other - Last Name:HARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033
Practice Address - Country:US
Practice Address - Phone:717-531-6597
Practice Address - Fax:717-531-7790
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161216367500000X
PARN589731367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered