Healthcare Provider Details

I. General information

NPI: 1780940197
Provider Name (Legal Business Name): JENNIFER HARRISON FREGO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CENTER ST DIVISION OF NEONATOLOGY
MOBILE AL
36604-3301
US

IV. Provider business mailing address

1700 CENTER ST DIVISION OF NEONATOLOGY
MOBILE AL
36604-3301
US

V. Phone/Fax

Practice location:
  • Phone: 251-415-1270
  • Fax: 251-415-1049
Mailing address:
  • Phone: 251-415-1270
  • Fax: 251-415-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number1-090676
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: