Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 811237 | NV |
NPI | 1023421120 |
---|---|
Provider Name | Jeremy Friend |
First Address | Carson City, NV 89703-4625 |
Second Address | Carson City, NV 89703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2014 |
Last Update Date | 22/10/2018 |