Provider Demographics
NPI:1912313685
Name:MCFADDEN, PAMELA L
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 S RAINBOW BLVD
Mailing Address - Street 2:APT 1102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0624
Mailing Address - Country:US
Mailing Address - Phone:773-459-1168
Mailing Address - Fax:
Practice Address - Street 1:1580 E DESERT INN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2548
Practice Address - Country:US
Practice Address - Phone:702-836-9442
Practice Address - Fax:702-836-9367
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist