Individual
MR. MARSEAN JERELLE HARDAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
YOUTH INTAKE ADMIN
Contact information
Practice address
9001 HAVILAND RD, LAS VEGAS, NV 89123-0619
(702) 462-0067
Mailing address
PO BOX 633, SALT LAKE CITY, UT 84110-0633
(170) 246-2006
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/21/2023
Last updated
07/21/2023
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