Provider Demographics
NPI:1780297440
Name:LLEWELLYN, TAYLER MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:TAYLER
Middle Name:MARIE
Last Name:LLEWELLYN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5625 S 62ND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3558
Mailing Address - Country:US
Mailing Address - Phone:402-489-3834
Mailing Address - Fax:402-489-5049
Practice Address - Street 1:5625 S 62ND ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3558
Practice Address - Country:US
Practice Address - Phone:402-489-3834
Practice Address - Fax:402-489-5049
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE2513363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant