Provider Demographics
NPI:1245650373
Name:TAYLOR, DETRIA
Entity type:Individual
Prefix:
First Name:DETRIA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DETRIA THE PET'S
Other - Middle Name:
Other - Last Name:COMPANION, LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:421 GARLAND ST
Mailing Address - Street 2:APT 203
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2517
Mailing Address - Country:US
Mailing Address - Phone:810-908-4363
Mailing Address - Fax:
Practice Address - Street 1:421 GARLAND ST
Practice Address - Street 2:APT 203
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2517
Practice Address - Country:US
Practice Address - Phone:810-908-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No171W00000XOther Service ProvidersContractor
No372600000XNursing Service Related ProvidersAdult Companion
No374J00000XNursing Service Related ProvidersDoula