Provider Demographics
NPI:1992520126
Name:FRENTRESS, JESSICA (FDNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FRENTRESS
Suffix:
Gender:F
Credentials:FDNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28704 COUNTY ROAD 141
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-7605
Mailing Address - Country:US
Mailing Address - Phone:701-412-8715
Mailing Address - Fax:
Practice Address - Street 1:28704 COUNTY ROAD 141
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-7605
Practice Address - Country:US
Practice Address - Phone:701-412-8715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2228398163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse