Individual
MR. JUSTIN WILLIAM FREDERICKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
720 WOOD ST, EUREKA, CA 95501-4413
(707) 268-2994
Mailing address
720 WOOD ST, EUREKA, CA 95501-4413
(707) 268-2994
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
LPN15722
NV
167G00000X
Licensed Psychiatric Technician
Primary
—
—
Other
Enumeration date
05/16/2015
Last updated
05/02/2021
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