Individual
MRS. KIMBERLY FREDERICK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
799 LEXINGTON AVE, MANSFIELD, OH 44907-1906
(419) 756-5133
(419) 774-9707
Mailing address
130 SAMARITAN AVE, ASHLAND, OH 44805-3927
(419) 756-5133
(419) 774-9707
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN193878
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2290668
—
OH
Enumeration date
09/22/2005
Last updated
07/09/2007
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