Healthcare Provider Details

I. General information

NPI: 1386675783
Provider Name (Legal Business Name): JUDY D FRUEH WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 UNIVERSITY DR
MARYVILLE MO
64468-6015
US

IV. Provider business mailing address

800 UNIVERSITY DR
MARYVILLE MO
64468-6015
US

V. Phone/Fax

Practice location:
  • Phone: 660-562-1348
  • Fax: 660-562-1585
Mailing address:
  • Phone: 660-562-1348
  • Fax: 660-562-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number104080
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: