Individual
IVY ANTINERO TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3500 GASTON AVE, DALLAS, TX 75246-2017
(214) 820-2139
Mailing address
PO BOX 650426, DALLAS, TX 75265-0426
(972) 233-1999
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
669612
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
669612
TEXAS STATE CRNA LICENSE
TX
Enumeration date
01/07/2009
Last updated
02/19/2009
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