MEDICARE: MRS. LISA MARIE FREUND APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	852807	NV

General Provider Information

NPI Number	:	1871243816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE FREUND APRN

Provider Business Mailing Address
First Line	:	3041 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7446
Country	:	US
Telephone Number	:	702-460-2067
Fax Number	:

Provider Business Practice Location Address
First Line	:	3041 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7446
Country	:	US
Telephone Number	:	702-460-2067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	05/24/2023

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