Healthcare Provider Details

I. General information

NPI: 1952075475
Provider Name (Legal Business Name): FREJA BURGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2021
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WELLS ST
WESTERLY RI
02891-2961
US

IV. Provider business mailing address

154 LIGHTHOUSE DR
SAUGERTIES NY
12477-4257
US

V. Phone/Fax

Practice location:
  • Phone: 401-348-0008
  • Fax:
Mailing address:
  • Phone: 603-682-7627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number03638
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403786
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12141
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number817045
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: