Healthcare Provider Details

I. General information

NPI: 1083303945
Provider Name (Legal Business Name): FREWYNE A MESSFNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10022 W HESS ST
TOLLESON AZ
85353-1235
US

IV. Provider business mailing address

10022 W HESS ST
TOLLESON AZ
85353-1235
US

V. Phone/Fax

Practice location:
  • Phone: 303-856-5257
  • Fax:
Mailing address:
  • Phone: 303-856-5257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberD09521021
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: