Provider Demographics
NPI:1821127655
Name:TAYLOR, WILLIAM N (LPN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:N
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CARRIAGE LN SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-7862
Mailing Address - Country:US
Mailing Address - Phone:616-281-5130
Mailing Address - Fax:
Practice Address - Street 1:1256 WALKER AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4067
Practice Address - Country:US
Practice Address - Phone:616-235-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703082102164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse