Provider Demographics
NPI:1205843273
Name:FRICK, WILLIAM HANS (CRNA/APRN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HANS
Last Name:FRICK
Suffix:
Gender:M
Credentials:CRNA/APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 LEDGE RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2526
Mailing Address - Country:US
Mailing Address - Phone:860-747-8140
Mailing Address - Fax:
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:PROVIDER ENROLLMENT
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-2212
Practice Address - Country:US
Practice Address - Phone:860-679-7503
Practice Address - Fax:860-679-1610
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000179363L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004269800Medicaid