MEDICARE: TAZANNA TERRELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1154263390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAZANNA TERRELL

Provider Business Mailing Address
First Line	:	5636 S SANGAMON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2208
Country	:	US
Telephone Number	:	309-703-5609
Fax Number	:

Provider Business Practice Location Address
First Line	:	5636 S SANGAMON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2208
Country	:	US
Telephone Number	:	309-703-5609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ TAZANNA TERRELL ” Practice Location

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