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General NPI Number Information
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NPI Number | 1861554818
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Entity Type | Individual
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Provider Name | NANCY J FREDO CNM
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 1108 SOUTH ST
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City | NACOGDOCHES
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State | TX
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Zip | 75964-5986
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Country | US
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Telephone | 936-560-3097
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Fax | 936-462-8080
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Provider Business Mailing Address
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Address Line | PO BOX 3488
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City | TUPELO
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State | MS
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Zip | 38803-3488
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Country | US
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Telephone | 936-568-8425
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Fax | 936-568-8570
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 599046
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License Number State | TX
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