| NPI | 1508384868 |
|---|---|
| Former Name | KATHRYN RAE FREDERICKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 102355) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A129763) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2024-12-04 |