MEDICARE: DR. ANDREA PERNELL M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	7834	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053301580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA PERNELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 400205
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89140-0205
Country	:	US
Telephone Number	:	702-566-2455
Fax Number	:	702-870-2214

Provider Business Practice Location Address
First Line	:	2810 W CHARLESTON BLVD
Second Line	:	SUITE 48
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1921
Country	:	US
Telephone Number	:	702-870-2213
Fax Number	:	702-870-2214

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	12/29/2013

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Directions to “ DR. ANDREA PERNELL M.D.” Practice Location

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