Individual
FREW FIKRU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
529 WASHINGTON AVE APT 2, REVERE, MA 02151-1962
(617) 230-0979
Mailing address
529 WASHINGTON AVE APT 2, REVERE, MA 02151-1962
(617) 230-0979
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
AG111190002
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AG11190002
PROFESSIONAL LICENSE
—
05
—
AG11190002
—
MA
Enumeration date
03/18/2020
Last updated
03/18/2020
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