Basic Information
| Provider Information | |||||||||
| NPI: | 1972586378 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTHOLOMEW | ||||||||
| FirstName: | LLYERN | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | C.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 BENFIELD BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211083002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107295100 | ||||||||
| FaxNumber: | 4107295156 | ||||||||
| Practice Location | |||||||||
| Address1: | 7711 QUARTERFIELD RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210614492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107615600 | ||||||||
| FaxNumber: | 4107615734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 01/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R045605 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 643295-03 | 01 | MD | CAREFIRST MD RENDERING | OTHER | P00380110 | 01 | MD | RR MEDICARE | OTHER | 103190 | 01 | MD | JHHC PROVIDER NUMBER | OTHER | 1971385 | 01 | MD | AETNA HMO | OTHER | 406316300 | 05 | MD | MEDICAID | 7605-0078 | 01 | MD | CAREFIRST BLUECHOICE | OTHER | 9727215 | 01 | MD | AETNA PPO | OTHER |