Provider Demographics
NPI:1689359945
Name:TAYLOR, CHONDEE DIONNE
Entity Type:Individual
Prefix:
First Name:CHONDEE
Middle Name:DIONNE
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 1:6917 N 71ST AVE APT 1034
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-3958
Mailing Address - Country:US
Mailing Address - Phone:262-880-0644
Mailing Address - Fax:
Practice Address - Street 1:6917 N 71ST AVE APT 1034
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-3958
Practice Address - Country:US
Practice Address - Phone:262-880-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1000057227343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)