MEDICARE: DR. JEREMY HASKELL PSYD

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1710948849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY HASKELL PSYD

Provider Business Mailing Address
First Line	:	4250 GRIFFISS AVE
Second Line	:	432D WING (ATTN: MAJ. JEREMY HASKELL)
City	:	NELLIS AIR FORCE BASE
State	:	NV
Zip	:	89191
Country	:	US
Telephone Number	:	702-404-3986
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 GRIFFISS AVE
Second Line	:	432D WING (ATTN: MAJ. JEREMY HASKELL)
City	:	NELLIS AIR FORCE BASE
State	:	NV
Zip	:	89191
Country	:	US
Telephone Number	:	702-404-3986
Fax Number	:

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	12/26/2013

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