Basic Information
| Provider Information | |||||||||
| NPI: | 1427401819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREDERICKSEN | ||||||||
| FirstName: | MEGAN | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 BOTTINEAU BLVD STE 210 | ||||||||
| Address2: | |||||||||
| City: | CRYSTAL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554293184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635877000 | ||||||||
| FaxNumber: | 7635877015 | ||||||||
| Practice Location | |||||||||
| Address1: | 9825 HOSPITAL DR STE 205 | ||||||||
| Address2: | |||||||||
| City: | MAPLE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553694480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635877000 | ||||||||
| FaxNumber: | 7635877015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2016 | ||||||||
| LastUpdateDate: | 07/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | CNP 4662 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.