MEDICARE: ANGELA 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	164W00000X	Licensed Practical Nurse	303700-031	WI

General Provider Information

NPI Number	:	1447509096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA TAYLOR

Provider Business Mailing Address
First Line	:	7925 WHITETAIL DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-1750
Country	:	US
Telephone Number	:	262-994-7871
Fax Number	:

Provider Business Practice Location Address
First Line	:	7925 WHITETAIL DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-1750
Country	:	US
Telephone Number	:	262-994-7871
Fax Number	:

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

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	08/29/2012

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