Provider Demographics
NPI:1437648573
Name:FRAELICH, KARIN GENETTE (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:KARIN
Middle Name:GENETTE
Last Name:FRAELICH
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:GENETTE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:13290 E COUNTY ROAD 12
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:OH
Mailing Address - Zip Code:44807-9501
Mailing Address - Country:US
Mailing Address - Phone:419-217-1146
Mailing Address - Fax:
Practice Address - Street 1:22 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMVILLE
Practice Address - State:OH
Practice Address - Zip Code:44818-9399
Practice Address - Country:US
Practice Address - Phone:419-983-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN430097163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse