Individual
MICAH TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 S MOORE AVE, CLAREMORE, OK 74017-5047
(918) 342-6200
Mailing address
14303 E 83RD PL N APT 206, OWASSO, OK 74055-7653
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
223553
TN
Other
Enumeration date
09/24/2019
Last updated
09/24/2019
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