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Individual

MRS. MARTHA MARIE TAYLOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1970 S RIDGE RD, GREEN BAY, WI 54304-4125
(920) 430-4888
(920) 430-4889
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
363A00000X
Physician Assistant
13156
MN
363A00000X
Physician Assistant
Primary
5583-23
WI

Other

Enumeration date
05/14/2019
Last updated
08/08/2023
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