Healthcare Provider Details

I. General information

NPI: 1841277209
Provider Name (Legal Business Name): FREMONT WOMEN'S HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N TENAYA WAY STE 635
LAS VEGAS NV
89128-0443
US

IV. Provider business mailing address

PO BOX 612
LAS VEGAS NV
89125-0612
US

V. Phone/Fax

Practice location:
  • Phone: 702-870-2939
  • Fax: 702-870-2826
Mailing address:
  • Phone: 702-671-6800
  • Fax: 702-671-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JON GREG GRIFFIN
Title or Position: CEO
Credential:
Phone: 702-671-6800