MEDICARE: CANDICE MAE FRYDA APRN

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
1	363L00000X	Nurse Practitioner	111805	NE
2	363LP2300X	Primary Care Nurse Practitioner	111805	NE
3	363LF0000X	Family Nurse Practitioner	111805	NE

General Provider Information

NPI Number	:	1841678497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE MAE FRYDA APRN

Provider Business Mailing Address
First Line	:	3105 N 93RD ST # 68134
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-4717
Country	:	US
Telephone Number	:	402-554-1045
Fax Number	:

Provider Business Practice Location Address
First Line	:	3105 N 93RD ST # 68134
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-4717
Country	:	US
Telephone Number	:	402-554-1045
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	03/13/2026

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Directions to “ CANDICE MAE FRYDA APRN” Practice Location

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