MEDICARE: LUEELLA BARNES

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1235774126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUEELLA BARNES

Provider Business Mailing Address
First Line	:	913 E OGDEN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-4234
Country	:	US
Telephone Number	:	702-689-5015
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 W CHARLESTON BLVD APT 2084
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1298
Country	:	US
Telephone Number	:	661-492-0931
Fax Number	:

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

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	11/14/2019

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Directions to “ LUEELLA BARNES ” Practice Location

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