Provider Demographics
NPI:1972586378
Name:BARTHOLOMEW, LLYERN L (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LLYERN
Middle Name:L
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:7711 QUARTERFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4492
Practice Address - Country:US
Practice Address - Phone:410-761-5600
Practice Address - Fax:410-761-5734
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR045605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD643295-03OtherCAREFIRST MD RENDERING
MDP00380110OtherRR MEDICARE
MD103190OtherJHHC PROVIDER NUMBER
MD1971385OtherAETNA HMO
MD406316300Medicaid
MD7605-0078OtherCAREFIRST BLUECHOICE
MD9727215OtherAETNA PPO
MDQ60332Medicare UPIN
MD226LM972Medicare PIN