Provider Demographics
NPI:1760576474
Name:LLEWELLYN, NANCY HOOVER (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:HOOVER
Last Name:LLEWELLYN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 32ND ST.
Mailing Address - Street 2:STE A
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221
Mailing Address - Country:US
Mailing Address - Phone:360-293-4343
Mailing Address - Fax:
Practice Address - Street 1:912 32ND ST
Practice Address - Street 2:STE A
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-3473
Practice Address - Country:US
Practice Address - Phone:360-293-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1112648Medicaid
WA1492LLOtherREGENCE BLUE SHIELD
WA147029OtherWORKMANS COMP
WA1492LLOtherREGENCE BLUE SHIELD
E15061Medicare UPIN
WA1112648Medicaid