Healthcare Provider Details

I. General information

NPI: 1356899140
Provider Name (Legal Business Name): ANGELA DAWN TAYLOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 LINN ST
CINCINNATI OH
45203-1314
US

IV. Provider business mailing address

4019 MATSON AVE
CINCINNATI OH
45236-2341
US

V. Phone/Fax

Practice location:
  • Phone: 513-233-7100
  • Fax:
Mailing address:
  • Phone: 513-708-9385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.019773
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: