Individual
MRS. TANNER NICHOLE TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2621 S ONEIDA ST, GREEN BAY, WI 54304-5793
(920) 499-3511
Mailing address
2621 S ONEIDA ST STE 104, GREEN BAY, WI 54304-5793
(920) 499-3511
(920) 499-9215
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3806-35
WI
Other
Enumeration date
08/05/2022
Last updated
09/26/2022
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