MEDICARE: AMOS VLADIMIR ELIEN JR.

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	163W00000X	Registered Nurse	RN9503484	FL

General Provider Information

NPI Number	:	1689139222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMOS VLADIMIR ELIEN JR.

Provider Business Mailing Address
First Line	:	5029 FOREST DALE DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33449-4626
Country	:	US
Telephone Number	:	561-315-8931
Fax Number	:

Provider Business Practice Location Address
First Line	:	5029 FOREST DALE DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33449-4626
Country	:	US
Telephone Number	:	561-315-8931
Fax Number	:

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

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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Directions to “ AMOS VLADIMIR ELIEN JR. ” Practice Location

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