Provider Demographics
NPI:1073236345
Name:TAYLOR, TAMARA D
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:D
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 1:7777 BONHOMME AVE STE 1838
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1911
Mailing Address - Country:US
Mailing Address - Phone:314-489-6777
Mailing Address - Fax:
Practice Address - Street 1:7777 BONHOMME AVE STE 1838
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1911
Practice Address - Country:US
Practice Address - Phone:314-489-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care