Provider Demographics
NPI:1275282253
Name:TAYLOR, DOMINIQUE
Entity Type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:
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 1:2605 BETTY ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-5553
Mailing Address - Country:US
Mailing Address - Phone:318-865-2311
Mailing Address - Fax:318-865-2312
Practice Address - Street 1:2605 BETTY ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-5553
Practice Address - Country:US
Practice Address - Phone:318-865-2311
Practice Address - Fax:318-865-2312
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant