MEDICARE: MRS. LAUREN CRYSTANN TAYLOR PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA1684	NV

General Provider Information

NPI Number	:	1588039739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN CRYSTANN TAYLOR PA-C

Provider Business Mailing Address
First Line	:	1808 SOLVANG MILL DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1413
Country	:	US
Telephone Number	:	847-668-3408
Fax Number	:

Provider Business Practice Location Address
First Line	:	6592 N DECATUR BLVD
Second Line	:	UNIT 115
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-1037
Country	:	US
Telephone Number	:	702-496-3392
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2015
Last Update Date	:	12/13/2015

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