MEDICARE: JOHNNY ALEX TOLER

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	376K00000X	Nurse's Aide	CNA034060	NV
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1437760444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNY ALEX TOLER

Provider Business Mailing Address
First Line	:	562 TWILIGHT BLUE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8227
Country	:	US
Telephone Number	:	323-218-1535
Fax Number	:

Provider Business Practice Location Address
First Line	:	562 TWILIGHT BLUE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8227
Country	:	US
Telephone Number	:	323-218-1535
Fax Number	:

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

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	08/13/2020

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Directions to “ JOHNNY ALEX TOLER ” Practice Location

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