Individual
JULIEANNE DANIELLE FREDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-1000
Mailing address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-1000
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2010039959
MO
363LF0000X
Family Nurse Practitioner
Primary
4704292329
MI
363LF0000X
Family Nurse Practitioner
F01190058
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704292329
FAMILY NURSE PRACTITIONER
MI
01
—
F01190058
RN LICENSE #: 2010039959
MO
Enumeration date
01/16/2019
Last updated
03/16/2025
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