Provider Demographics
NPI:1285314674
Name:LLEWELYN, TAYLOR MARIE (RN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:LLEWELYN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:MARIE
Other - Last Name:BEAVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:339 E 3900 S STE 155
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-1978
Mailing Address - Country:US
Mailing Address - Phone:801-236-1056
Mailing Address - Fax:
Practice Address - Street 1:339 E 3900 S STE 155
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1978
Practice Address - Country:US
Practice Address - Phone:801-263-1056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12144180-3102163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management