Provider Demographics
NPI:1487639118
Name:FREIDINGER, CONSTANCE M (PA-C)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:M
Last Name:FREIDINGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:
Other - Last Name:SWORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2214 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-3221
Mailing Address - Country:US
Mailing Address - Phone:309-680-7669
Mailing Address - Fax:309-681-8443
Practice Address - Street 1:320 E ARMSTRONG AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603
Practice Address - Country:US
Practice Address - Phone:309-680-7600
Practice Address - Fax:309-495-8614
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002724363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK51192Medicare PIN