Provider Demographics
NPI:1285425272
Name:FRY, TAYLOR MICHELLE LOUISE (CNM)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MICHELLE LOUISE
Last Name:FRY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:MICHELLE
Other - Last Name:PLOURDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:636 GERRY ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3652
Mailing Address - Country:US
Mailing Address - Phone:815-307-1722
Mailing Address - Fax:
Practice Address - Street 1:636 GERRY ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3652
Practice Address - Country:US
Practice Address - Phone:815-307-1722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife