Provider Demographics
NPI:1285040345
Name:FREDRICKSON, ASHLEY DONIA (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DONIA
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4675 E 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-2343
Mailing Address - Country:US
Mailing Address - Phone:303-289-1086
Mailing Address - Fax:
Practice Address - Street 1:8030 IRVING ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-4124
Practice Address - Country:US
Practice Address - Phone:303-428-4384
Practice Address - Fax:720-542-4027
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0185530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner