Individual
MR. FREDERIC LELAND ONDOVCHAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.N., M.S.N., A.P.R.
Contact information
Practice address
13175 E STATE ROUTE 169, DEWEY, AZ 86327-7416
(928) 632-1155
(928) 632-5580
Mailing address
601 TAPCO LN, CLARKDALE, AZ 86324-3415
(609) 707-5291
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
26NJ00523800
NJ
363LF0000X
Family Nurse Practitioner
Primary
AP9884
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302368
—
AZ
Enumeration date
10/21/2014
Last updated
05/16/2022
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