Provider Demographics
NPI:1093058661
Name:MCFADDEN, GWEN JANISE
Entity Type:Individual
Prefix:MS
First Name:GWEN
Middle Name:JANISE
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GWEN
Other - Middle Name:JANISE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6889 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4687
Mailing Address - Country:US
Mailing Address - Phone:702-434-1200
Mailing Address - Fax:
Practice Address - Street 1:6889 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4687
Practice Address - Country:US
Practice Address - Phone:702-434-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor