Healthcare Provider Details

I. General information

NPI: 1912312372
Provider Name (Legal Business Name): LYNN G FREDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 S RURAL RD
TEMPE AZ
85282-3853
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 480-304-5467
  • Fax: 480-304-5468
Mailing address:
  • Phone: 615-425-4211
  • Fax: 615-425-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5680
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN159544
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: