Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1083904908 |
---|---|
Provider Name | Renae Frederick |
First Address | Las Vegas, NV 89131-6103 |
Second Address | Las Vegas, NV 89113-0152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2011 |
Last Update Date | 12/04/2011 |