Provider Demographics
NPI:1497346845
Name:FREDERICK, LAUREN MARIE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:WOJDYLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:STE 265
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9623
Mailing Address - Country:US
Mailing Address - Phone:815-955-1481
Mailing Address - Fax:
Practice Address - Street 1:1890 SILVER CROSS BLVD STE 275
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9528
Practice Address - Country:US
Practice Address - Phone:815-727-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022496363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner