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Organization
JOHANNA S. FRICKE, M.D., LLC
Active
Organization
JOHANNA S. FRICKE, M.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHANNA FRICKE M.D. (PHYSICIAN/CEO)
(702) 804-9065
Entity
Organization
Contact information
Practice address
311 N BUFFALO DR, SUITE B, LAS VEGAS, NV 89145-0375
(702) 877-2520
(702) 877-2521
Mailing address
1300 PREMIER CT, LAS VEGAS, NV 89117-7134
(702) 804-9065
(702) 877-2521
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
NV
261QD1600X
Developmental Disabilities Clinic/Center
—
NV
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NV
261QM2500X
Medical Specialty Clinic/Center
—
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002002223
—
NV
01
—
003102223
MEDICARE ID-TYPE UNSPECIFIED/NV MEDICAID
NV
01
—
32876
MEDICARE ID-TYPE UNSPECIFIED/MEDICARE
NV
01
—
CS09750
STATE PHARMACY
NV
Enumeration date
02/03/2014
Last updated
03/07/2023
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