MEDICARE: MUSUDEEN ANGEL HARRELL RN

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	163WC1500X	Community Health Registered Nurse	148064	MO

General Provider Information

NPI Number	:	1578682928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUSUDEEN ANGEL HARRELL RN

Provider Business Mailing Address
First Line	:	300 SW NOEL ST
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-3810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 SW NOEL ST
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-3810
Country	:	US
Telephone Number	:	816-678-8061
Fax Number	:	816-774-4389

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/03/2023

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