Provider Demographics
NPI:1518288190
Name:HARRELL, JOHN W
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:HARRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 BERESIK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89115
Mailing Address - Country:US
Mailing Address - Phone:228-424-1438
Mailing Address - Fax:
Practice Address - Street 1:4813 BERESIK CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-2228
Practice Address - Country:US
Practice Address - Phone:228-424-1438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9204030286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital