Provider Demographics
NPI:1598403958
Name:FREY, JANIE RUTH (RN)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:RUTH
Last Name:FREY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7390 FORTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1429
Mailing Address - Country:US
Mailing Address - Phone:719-237-0911
Mailing Address - Fax:
Practice Address - Street 1:3524 AIRFIELD RD
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4701
Practice Address - Country:US
Practice Address - Phone:719-524-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0122818163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management