Healthcare Provider Details

I. General information

NPI: 1336681675
Provider Name (Legal Business Name): PATRICK FREE APRN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

IV. Provider business mailing address

5209 GENTLE RIVER AVE
LAS VEGAS NV
89130-2931
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-5000
  • Fax:
Mailing address:
  • Phone: 702-240-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002381
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: