Healthcare Provider Details

I. General information

NPI: 1780183871
Provider Name (Legal Business Name): JULIE FREDERICK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 O ST
LINCOLN NE
68510-2235
US

IV. Provider business mailing address

4500 BIRCH HOLLOW DR
LINCOLN NE
68516-5105
US

V. Phone/Fax

Practice location:
  • Phone: 402-436-1655
  • Fax:
Mailing address:
  • Phone: 402-730-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number37789
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number37789
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: