Provider Demographics
NPI:1730761438
Name:TAYLOR, ANTOINETTE ROSE
Entity type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:ROSE
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 1:729 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1941
Mailing Address - Country:US
Mailing Address - Phone:317-529-9667
Mailing Address - Fax:
Practice Address - Street 1:729 E 48TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1941
Practice Address - Country:US
Practice Address - Phone:317-529-9667
Practice Address - Fax:313-731-1864
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health