Individual
TAYLOR MARIE NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1266 N FORWARD RD, LAKE CITY, MI 49651-9393
(231) 920-8152
Mailing address
1266 N FORWARD RD, LAKE CITY, MI 49651-9393
(231) 920-8152
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AM570363712
MI
Other
Enumeration date
05/13/2026
Last updated
05/13/2026
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