Provider Demographics
NPI:1598533564
Name:TAYLOR, PHYLIESS LASHAWN
Entity Type:Individual
Prefix:
First Name:PHYLIESS
Middle Name:LASHAWN
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 1:26150 KOONTZ ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4925
Mailing Address - Country:US
Mailing Address - Phone:313-898-1285
Mailing Address - Fax:
Practice Address - Street 1:26150 KOONTZ ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4925
Practice Address - Country:US
Practice Address - Phone:313-898-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide