Individual
DR. O'ANN KARIN FREDSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
610 WEST BROADWAY, SUITE L02, JACKSON, WY 83001
(307) 734-8800
(307) 734-8900
Mailing address
P O BOX 15540, JACKSON, WY 83002
(307) 734-8800
(307) 734-8900
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5032A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113880400
—
WY
Enumeration date
11/09/2006
Last updated
07/08/2007
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