Provider Demographics
NPI:1982838231
Name:LLEWELLYN, ROBERT STEPHEN (LPN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STEPHEN
Last Name:LLEWELLYN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 15281 BOX 723
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205-5281
Mailing Address - Country:US
Mailing Address - Phone:0103-223-6885
Mailing Address - Fax:0103-223-6885
Practice Address - Street 1:121 CSH UNIT 15244
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205-5244
Practice Address - Country:US
Practice Address - Phone:317-737-5575
Practice Address - Fax:317-737-3036
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
B1635580146N00000X
TX204900164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic