Healthcare Provider Details

I. General information

NPI: 1750145298
Provider Name (Legal Business Name): DENISE MARIE FREDERICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 SKYLINE DR
SAINT MICHAEL ND
58370-7001
US

IV. Provider business mailing address

602 SKYLINE DR
SAINT MICHAEL ND
58370-7001
US

V. Phone/Fax

Practice location:
  • Phone: 701-230-2823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: