Provider Demographics
NPI:1417410705
Name:FREMAREK, NICOLE (DO, MBA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FREMAREK
Suffix:
Gender:F
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 INNOVATION DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6618
Mailing Address - Country:US
Mailing Address - Phone:540-232-8405
Mailing Address - Fax:833-464-3281
Practice Address - Street 1:1691 INNOVATION DR STE 2100
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6618
Practice Address - Country:US
Practice Address - Phone:540-232-8405
Practice Address - Fax:833-464-3281
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102207135204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program