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General NPI Number Information
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NPI Number | 1174103899
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Entity Type | Individual
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Provider Name | SAMANTHA FRECK MSN, APRN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 18697 BAGLEY RD
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City | CLEVELAND
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State | OH
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Zip | 44130-3417
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Country | US
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Telephone | 440-816-6051
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Fax | 440-816-6053
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Provider Business Mailing Address
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Address Line | 18697 BAGLEY RD
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City | CLEVELAND
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State | OH
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Zip | 44130-3417
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Country | US
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Telephone | 440-816-6051
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Fax | 440-816-6053
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.0028317
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License Number State | OH
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