Provider Demographics
NPI:1578565198
Name:FREDRICKSON, SARI (MS, NP)
Entity Type:Individual
Prefix:MS
First Name:SARI
Middle Name:
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:MS, NP
Other - Prefix:MS
Other - First Name:SARI
Other - Middle Name:
Other - Last Name:FREDRICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MS, NP
Mailing Address - Street 1:1425 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5318
Mailing Address - Country:US
Mailing Address - Phone:925-295-4000
Mailing Address - Fax:
Practice Address - Street 1:1425 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5318
Practice Address - Country:US
Practice Address - Phone:925-295-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288960363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health