| NPI | 1285005470 |
|---|---|
| Former Name | TARA J FREDRICKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AZ ap8273) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ RN00000099202) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CO 1161) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: ND r53837) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 9886) | |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2023-03-27 |