Provider Demographics
NPI:1861031957
Name:TAYLOR, REBECCA (RN, BSN, CPN, IBCLC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN, BSN, CPN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 LIVERNOIS RD STE 175
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5058
Mailing Address - Country:US
Mailing Address - Phone:704-460-8408
Mailing Address - Fax:
Practice Address - Street 1:3150 LIVERNOIS RD STE 175
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5058
Practice Address - Country:US
Practice Address - Phone:704-460-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704268816163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant