Provider Demographics
NPI:1588039739
Name:TAYLOR, LAUREN CRYSTANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:CRYSTANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 SOLVANG MILL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1413
Mailing Address - Country:US
Mailing Address - Phone:847-668-3408
Mailing Address - Fax:
Practice Address - Street 1:6592 N DECATUR BLVD
Practice Address - Street 2:UNIT 115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-1037
Practice Address - Country:US
Practice Address - Phone:702-496-3392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1684363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical