Provider Demographics
NPI:1538929070
Name:BLASIUS LABORDE, TAYLOR MCKENZIE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MCKENZIE
Last Name:BLASIUS LABORDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:LABORDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1956 RIVER PARK CT
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2840
Mailing Address - Country:US
Mailing Address - Phone:715-203-5865
Mailing Address - Fax:
Practice Address - Street 1:1956 RIVER PARK CT
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2840
Practice Address - Country:US
Practice Address - Phone:715-203-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program