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NPI Code Detail

MEDICARE: ERIC JAMES FREDERICKS CNA

MEDICARE: ERIC JAMES FREDERICKS CNA
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
1376K00000XNurse's Aide10046143OR

General Provider Information

NPI Number : 1659233419
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC JAMES FREDERICKS CNA
Provider Business Mailing Address
First Line : 4330 SE FLEMING ST
Second Line :
City : NEWPORT
State : OR
Zip : 97366-9692
Country : US
Telephone Number : 707-880-2364
Fax Number :
Provider Business Practice Location Address
First Line : 835 SW 11TH ST
Second Line :
City : NEWPORT
State : OR
Zip : 97365-4802
Country : US
Telephone Number : 541-265-5356
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2025
Last Update Date : 12/01/2025

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Directions to “ ERIC JAMES FREDERICKS CNA” Practice Location

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