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NPI Code Detail

MEDICARE: NANCY J FREDO CNM

MEDICARE: NANCY J FREDO CNM
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
1367A00000XAdvanced Practice Midwife599046TX

General Provider Information

NPI Number : 1861554818
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY J FREDO CNM
Provider Business Mailing Address
First Line : PO BOX 3488
Second Line :
City : TUPELO
State : MS
Zip : 38803-3488
Country : US
Telephone Number : 936-568-8425
Fax Number : 936-568-8570
Provider Business Practice Location Address
First Line : 1108 SOUTH ST
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75964-5986
Country : US
Telephone Number : 936-560-3097
Fax Number : 936-462-8080
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 07/09/2019

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Directions to “ NANCY J FREDO CNM” Practice Location

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