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NPI Code Detail

MEDICARE: RACHEL L FREDERICKSON PA-C

MEDICARE: RACHEL L FREDERICKSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant3263CO

General Provider Information

NPI Number : 1346215894
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL L FREDERICKSON PA-C
Provider Business Mailing Address
First Line : 9348 GRAND CORDERA PKWY
Second Line : SUITE 160
City : COLORADO SPRINGS
State : CO
Zip : 80924-7023
Country : US
Telephone Number : 719-355-1585
Fax Number : 719-623-2983
Provider Business Practice Location Address
First Line : 9348 GRAND CORDERA PKWY
Second Line : 160
City : COLORADO SPRINGS
State : CO
Zip : 80924-7023
Country : US
Telephone Number : 719-355-1585
Fax Number : 719-623-2983
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2006
Last Update Date : 11/04/2020

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Directions to “ RACHEL L FREDERICKSON PA-C” Practice Location

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