Organization Name: | FREEDOM FAMILY MEDICAL SERVICES LLC |
NPI Number: | 1356763916 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT LYNN (OWNER) |
Mailing Address: | 555 California Ave Boulder City |
State: | NV US |
Postal Code: | 890052757 |
Phone Number: | 7022935945 |
Fax Number: | 7022935168 |
NPI Enumeration Date: | 01/15/2014 |
NPI Last Update Date: | 01/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |