MEDICARE: JANIE RUTH FREY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	RN0122818	CO

General Provider Information

NPI Number	:	1598403958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIE RUTH FREY RN

Provider Business Mailing Address
First Line	:	7390 FORTMAN AVE
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-1429
Country	:	US
Telephone Number	:	719-237-0911
Fax Number	:

Provider Business Practice Location Address
First Line	:	3524 AIRFIELD RD
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4701
Country	:	US
Telephone Number	:	719-524-6626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	05/25/2022

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