MEDICARE: DIANNA WALTON-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	347C00000X	Private Vehicle	W43517370867	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992365357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNA WALTON-TAYLOR

Provider Business Mailing Address
First Line	:	186 JOYCE LN
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	186 JOYCE LN
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1013
Country	:	US
Telephone Number	:	708-838-8979
Fax Number	:

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

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	06/18/2019

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