Provider Demographics
NPI:1083383558
Name:TAYLOR, DANANGE MARCHELL (FNP)
Entity type:Individual
Prefix:MS
First Name:DANANGE
Middle Name:MARCHELL
Last Name:TAYLOR
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-747-7236
Mailing Address - Fax:314-362-8099
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DEPT RADIATION ONCOLOGY, LL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-7236
Practice Address - Fax:314-362-8099
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020010573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420120257Medicaid