Healthcare Provider Details

I. General information

NPI: 1427744986
Provider Name (Legal Business Name): JENNIFER E. FRUEHLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 ARMORY RD
PARKTON NC
28371-8436
US

IV. Provider business mailing address

7690 ARABIA RD
LUMBER BRIDGE NC
28357-8990
US

V. Phone/Fax

Practice location:
  • Phone: 910-494-5888
  • Fax:
Mailing address:
  • Phone: 910-797-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP018865
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: