Basic Information
| Provider Information | |||||||||
| NPI: | 1093012874 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DONIELLE FREEDMAN, M.D. LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 370644 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891370644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023606003 | ||||||||
| FaxNumber: | 7023606006 | ||||||||
| Practice Location | |||||||||
| Address1: | 7336 W POST RD STE 109 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891136647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023606003 | ||||||||
| FaxNumber: | 7023606006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2011 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | FRIDAY | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALER | ||||||||
| AuthorizedOfficialTelephone: | 7028008988 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 261Q00000X | 7324 | NV | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.