Individual
LISA KAY FREDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
700 W IRONWOOD DR STE 350, COEUR D ALENE, ID 83814-4487
(208) 625-5230
(208) 625-5231
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-5085
(208) 625-5731
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP60945
ID
Other
Enumeration date
03/05/2019
Last updated
06/05/2019
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