Individual
KAREN J FREDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, WHNP, MSN, NP-C
Contact information
Practice address
4303 39TH AVE, KENOSHA, WI 53144-1969
(622) 653-4444
(262) 925-0440
Mailing address
4303 39TH AVE, KENOSHA, WI 53144-1969
(262) 653-4444
(262) 925-0440
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
78408-030
WI
363LF0000X
Family Nurse Practitioner
Primary
4412-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679569826
—
WI
05
—
43949100
—
WI
Enumeration date
09/23/2005
Last updated
07/14/2020
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