Individual
JASON PAUL FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
119 GRANSHIRE DR, BELLA VISTA, AR 72714-4917
(479) 633-3269
Mailing address
119 GRANSHIRE DR, BELLA VISTA, AR 72714-4917
(479) 633-3269
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R095610
AR
Other
Enumeration date
11/08/2022
Last updated
11/08/2022
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