Individual
TAYLOR RAE ROOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 KEPLER DR, GREEN BAY, WI 54311-8306
(920) 288-5555
(920) 288-5550
Mailing address
1035 KEPLER DR, GREEN BAY, WI 54311-8320
(920) 490-9046
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5382
WI
363A00000X
Physician Assistant
—
—
Other
Enumeration date
02/12/2020
Last updated
12/27/2023
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