MEDICARE: JHNELL L ELLIOTT

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	374J00000X	Doula

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	:	1396344891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JHNELL L ELLIOTT

Provider Business Mailing Address
First Line	:	1492 WOODCREST RD N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-5753
Country	:	US
Telephone Number	:	561-268-8596
Fax Number	:

Provider Business Practice Location Address
First Line	:	1492 WOODCREST RD N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-5753
Country	:	US
Telephone Number	:	561-268-8596
Fax Number	:

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

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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Directions to “ JHNELL L ELLIOTT ” Practice Location

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