Provider Demographics
NPI:1467711572
Name:FREY, DOUGLAS (MSN, NP-C, FNP)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:FREY
Suffix:
Gender:M
Credentials:MSN, NP-C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1205
Mailing Address - Country:US
Mailing Address - Phone:510-451-1273
Mailing Address - Fax:
Practice Address - Street 1:616 16TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1205
Practice Address - Country:US
Practice Address - Phone:510-451-1273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily