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General NPI Number Information
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NPI Number | 1104591387
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Entity Type | Organization
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Legal Business Name | FREEDOM WOUND CARE LLC
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 2965 S JONES BLVD STE E4
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City | LAS VEGAS
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State | NV
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Zip | 89146-5606
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Country | US
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Telephone | 702-910-1587
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Fax |
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Provider Business Mailing Address
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Address Line | 4889 WILLOW GLEN DR
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City | LAS VEGAS
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State | NV
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Zip | 89147-5266
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Country | US
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Telephone | 170-291-0158
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | RODELSON YUKEE
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Credential |
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Telephone | 702-910-1587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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