Individual
MR. MICHAEL ROBERT TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
705 LENA ST, SALMON, ID 83467-4208
(208) 756-8515
(208) 756-8385
Mailing address
705 LENA ST, SALMON, ID 83467-4208
(208) 756-8515
(208) 756-8385
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN-14621
ID
Other
Enumeration date
06/16/2020
Last updated
06/16/2020
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