Provider Demographics
NPI:1114279130
Name:FRERICHS, COURTNEY FURCINI (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:FURCINI
Last Name:FRERICHS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1160
Mailing Address - Country:US
Mailing Address - Phone:719-785-3519
Mailing Address - Fax:719-785-3554
Practice Address - Street 1:2940 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1160
Practice Address - Country:US
Practice Address - Phone:719-785-3519
Practice Address - Fax:719-785-3554
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0000622363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical