Provider Demographics
NPI:1003674276
Name:TAYLOR, DIANA A
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9964 ANGOLA RD
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-9191
Mailing Address - Country:US
Mailing Address - Phone:419-409-9893
Mailing Address - Fax:
Practice Address - Street 1:5123 RYAN RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2071
Practice Address - Country:US
Practice Address - Phone:567-698-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant