Individual
MR. NICHOLAS HENRY FREDERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN,CNP
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
(701) 364-8078
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-8000
(701) 364-8078
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R41352
ND
363LG0600X
Gerontology Nurse Practitioner
R41352
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1463647
—
ND
Enumeration date
09/17/2014
Last updated
12/28/2015
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