Individual
FREDENA LUCAS JAGGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2170 MIDLAND RD, SOUTHERN PINES, NC 28387-2927
(910) 295-1221
Mailing address
128 PEACHTREE LN STE B, ADVANCE, NC 27006-6783
(336) 624-1648
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
004545
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170062
LICENSE NUMBER
NC
01
—
430056454
HRH RR CRNA
NC
01
—
430079566
SCH RR CRNA
NC
05
—
8000180
—
NC
05
—
8000315
—
NC
01
—
8051710
MEDICAID CRNA PRO.
NC
Enumeration date
09/20/2006
Last updated
03/05/2024
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