Provider Demographics
NPI:1942671912
Name:KANGIOR, TAYLOR ANN
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:KANGIOR
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 1:11730 CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2035
Mailing Address - Country:US
Mailing Address - Phone:402-250-3755
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST STE 129
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2938
Practice Address - Country:US
Practice Address - Phone:402-614-9947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist