Healthcare Provider Details

I. General information

NPI: 1730210402
Provider Name (Legal Business Name): MICHAEL CHARLES FREDERICK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 COLLEGE AVE
BAKERSFIELD CA
93305-4172
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8123
  • Fax: 661-868-8188
Mailing address:
  • Phone: 661-868-6100
  • Fax: 661-868-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number376768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: