Fredrickson, Lance R

Fredrickson, Lance R is an individual health care provider with primary practice located at 510 E Clinton Ave , Athens TX 75751-3410. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Fredrickson, Lance R can be contacted via phone (903) 677-7434.

Contact Information

Primary practice address
510 E Clinton Ave Athens TX 75751-3410
Phone: (903) 677-7434
Fax: (903) 677-1472
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 200801739 Missouri

Profile Details

NPI number 1659522308
LBN Legal business name Fredrickson, Lance R
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 30th, 2008
Last updated Jan 19th, 2017 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659522308 NPPES
Texas MEDICAID 3504375-01

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