MEDICARE: ELLEN D JUVET NP

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	363LA2200X	Adult Health Nurse Practitioner	145659	MO
2	163WN0800X	Neuroscience Registered Nurse	F303664 / 505421	NY

General Provider Information

NPI Number	:	1750394789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN D JUVET NP

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MS 3021
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-3498
Country	:	US
Telephone Number	:	913-588-6122
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MS 3021
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-3498
Country	:	US
Telephone Number	:	913-588-6122
Fax Number	:

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/18/2014

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