Basic Information
Provider Information
NPI: 1073531737
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAMBY
FirstName: FREDA
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1701 W CHARLESTON BLVD
Address2: #215
City: LAS VEGAS
State: NV
PostalCode: 891022325
CountryCode: US
TelephoneNumber: 7026712395
FaxNumber: 7023825388
Practice Location
Address1: 1707 W CHARLESTON BLVD # VD
Address2: #120
City: LAS VEGAS
State: NV
PostalCode: 891022351
CountryCode: US
TelephoneNumber: 7026715140
FaxNumber: 7023852745
Other Information
ProviderEnumerationDate: 07/18/2006
LastUpdateDate: 04/17/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X6166TNN Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 
367A00000XAPN001097NVY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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