Fredrickson, Ethel
Fredrickson, Ethel is an individual health care provider with primary practice located at 1345 Circle Dr , Lake Village AR 71653-1593. She recently has only one registered license in Dietary & Nutritional Service Providers / Nutritionist, which is considered as her primary health care specialty. Fredrickson, Ethel can be contacted via phone (870) 265-0921.Contact Information
Primary practice address
1345 Circle Dr
Lake Village AR 71653-1593
Phone: (870) 265-0921
Fax: (844) 270-1949
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dietary & Nutritional Service Providers / Nutritionist | 133N00000X | 92236 | Arkansas |
Profile Details
| NPI number | 1154802866 |
|---|---|
| LBN Legal business name | Fredrickson, Ethel |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 22nd, 2018 |
| Last updated | Aug 22nd, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154802866 | NPPES |
| Arkansas | MEDICAID | 825296134 |
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