Provider Demographics
NPI:1114485364
Name:FREUDENTHAL, JESSICA ALICE (NP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALICE
Last Name:FREUDENTHAL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PARKSTON
Mailing Address - State:SD
Mailing Address - Zip Code:57366-2149
Mailing Address - Country:US
Mailing Address - Phone:775-343-5322
Mailing Address - Fax:
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:701-322-8988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001540363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner