Provider Demographics
NPI:1992779235
Name:FREDERICKS, PATRICIA CHAPMAN (RXN, CNM)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CHAPMAN
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:RXN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 E PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5304
Mailing Address - Country:US
Mailing Address - Phone:970-493-7442
Mailing Address - Fax:970-495-7991
Practice Address - Street 1:1106 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5304
Practice Address - Country:US
Practice Address - Phone:970-493-7442
Practice Address - Fax:970-495-7991
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO64550367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7026388Medicaid
COP55152Medicare UPIN
CO7026388Medicaid