MEDICARE: CHANELLI D ANGELA KELLY TAYLOR

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	163W00000X	Registered Nurse	RN412655	OH

General Provider Information

NPI Number	:	1104775733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANELLI D ANGELA KELLY TAYLOR

Provider Business Mailing Address
First Line	:	7002 CONSTITUTION DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-5103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7002 CONSTITUTION DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-5103
Country	:	US
Telephone Number	:	513-799-7177
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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