Individual
KEISHA MARIE FREDREGILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
401 E 16TH AVE, INDIANOLA, IA 50125-9704
(515) 664-7408
Mailing address
401 E 16TH AVE, INDIANOLA, IA 50125-9704
(515) 664-7408
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
H164076
IA
Other
Enumeration date
06/23/2021
Last updated
06/23/2021
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