Individual
NICHOLAS R FREDRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
555 E BROADWAY AVE STE 218, JACKSON, WY 83001-8640
(307) 739-4818
Mailing address
PO BOX 7005, JACKSON, WY 83002-7005
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
47072
WY
Other
Enumeration date
08/27/2024
Last updated
08/27/2024
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