Provider Demographics
NPI:1013124536
Name:TAYLOR, MICHELLE ALENA (RN, MSN, ACN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALENA
Last Name:TAYLOR
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Gender:F
Credentials:RN, MSN, ACN
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Mailing Address - Street 1:1194 PACIFIC STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-781-9111
Mailing Address - Fax:805-788-0764
Practice Address - Street 1:1194 PACIFIC STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-781-9111
Practice Address - Fax:805-788-0764
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2010-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA429752363LA2200X
CARN429752363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health