MEDICARE: IDA ELIZABETH BARNETTE-SPURLIN CARE COORDINATOR

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1750134052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDA ELIZABETH BARNETTE-SPURLIN CARE COORDINATOR

Provider Business Mailing Address
First Line	:	840 S RANCHO DR STE 4-337
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3837
Country	:	US
Telephone Number	:	702-440-8440
Fax Number	:

Provider Business Practice Location Address
First Line	:	7291 W CHARLESTON BLVD STE AB&120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1595
Country	:	US
Telephone Number	:	725-237-0080
Fax Number	:

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

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	04/08/2024

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