Individual
LANCE R FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
801 E WHEELER RD, MOSES LAKE, WA 98837-1820
(509) 765-5606
(509) 764-3244
Mailing address
660 S COOLIDGE ST, MOSES LAKE, WA 98837-1872
(509) 793-9715
(509) 764-3244
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
AP120956
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP61610317
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2307808
—
WA
05
—
3504375-01
—
TX
Enumeration date
09/30/2008
Last updated
04/25/2025
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