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General NPI Number Information
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NPI Number | 1336593722
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Entity Type | Individual
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Provider Name | JOHN NEIHLS
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Gender | Male
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 20558 E 1400TH AVE
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City | TEUTOPOLIS
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State | IL
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Zip | 62467-3644
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Country | US
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Telephone | 217-821-6852
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Fax | 580-628-2267
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Provider Business Mailing Address
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Address Line | 20558 E 1400TH AVE
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City | TEUTOPOLIS
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State | IL
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Zip | 62467-3644
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Country | US
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Telephone | 217-821-6852
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Fax | 580-628-2267
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 055235
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License Number State | IL
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