Provider Demographics
NPI:1750341442
Name:TAYLOR, NANCY JUNE (DO)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JUNE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1331 HORTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-5260
Mailing Address - Country:US
Mailing Address - Phone:517-784-4242
Mailing Address - Fax:517-784-6943
Practice Address - Street 1:1331 HORTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5260
Practice Address - Country:US
Practice Address - Phone:517-784-4242
Practice Address - Fax:517-784-6943
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2013-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
383314200OtherFEDERAL TAX ID NUMBER
P55430002Medicare PIN
383314200OtherFEDERAL TAX ID NUMBER