MEDICARE: MR. JOHN W HARRELL

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	286500000X	Military Hospital	RN 9204030	FL

General Provider Information

NPI Number	:	1518288190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN W HARRELL

Provider Business Mailing Address
First Line	:	4813 BERESIK CIRCLE
Second Line	:
City	:	NELLIS AFB
State	:	NV
Zip	:	89115
Country	:	US
Telephone Number	:	228-424-1438
Fax Number	:

Provider Business Practice Location Address
First Line	:	4813 BERESIK CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-2228
Country	:	US
Telephone Number	:	228-424-1438
Fax Number	:

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	06/17/2010

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