Individual
DIANNA WALTON-TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
186 JOYCE LN, CHICAGO HEIGHTS, IL 60411-1013
(708) 838-8979
Mailing address
186 JOYCE LN, CHICAGO HEIGHTS, IL 60411-1013
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
W43517370867
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
842126591
—
IL
Enumeration date
06/18/2019
Last updated
06/18/2019
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