Provider Demographics
NPI:1720490360
Name:FREDRICH, REBECCA (FNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FREDRICH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-3096
Mailing Address - Country:US
Mailing Address - Phone:660-438-5193
Mailing Address - Fax:660-438-5091
Practice Address - Street 1:1771 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3096
Practice Address - Country:US
Practice Address - Phone:660-438-5193
Practice Address - Fax:660-438-5091
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014015285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily