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NPI Code Detail

MEDICARE: MARJORY FREDERIC PMHNP-BC

MEDICARE: MARJORY FREDERIC PMHNP-BC
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
1163WC0400XCase Management Registered NurseRN78446NV
2363LP0808XPsychiatric/Mental Health Nurse Practitioner95032219CA
3363LP0808XPsychiatric/Mental Health Nurse Practitioner871409NV

General Provider Information

NPI Number : 1871294447
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARJORY FREDERIC PMHNP-BC
Provider Business Mailing Address
First Line : 5940 S RAINBOW BLVD STE 400
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-2507
Country : US
Telephone Number : 702-854-6853
Fax Number : 702-758-7315
Provider Business Practice Location Address
First Line : 5940 S RAINBOW BLVD STE 400
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-2507
Country : US
Telephone Number : 702-854-6853
Fax Number : 702-758-7315
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2023
Last Update Date : 05/24/2025

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Directions to “ MARJORY FREDERIC PMHNP-BC” Practice Location

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