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General NPI Number Information
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NPI Number | 1659233419
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Entity Type | Individual
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Provider Name | ERIC JAMES FREDERICKS CNA
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Gender | Male
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 835 SW 11TH ST
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City | NEWPORT
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State | OR
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Zip | 97365-4802
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Country | US
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Telephone | 541-265-5356
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Fax |
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Provider Business Mailing Address
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Address Line | 4330 SE FLEMING ST
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City | NEWPORT
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State | OR
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Zip | 97366-9692
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Country | US
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Telephone | 707-880-2364
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Fax |
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 10046143
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License Number State | OR
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