Individual
KRISTEN KELLY FREDERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4779 S FOREST POINT BLVD, NEW BERLIN, WI 53151-7476
(262) 894-4193
Mailing address
4779 S FOREST POINT BLVD, NEW BERLIN, WI 53151-7476
(262) 894-4193
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
14040-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100261245
—
WI
Enumeration date
06/05/2023
Last updated
04/12/2024
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