Provider Demographics
NPI:1609837962
Name:FOX, FRED DONALD (RN)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:DONALD
Last Name:FOX
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22873 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-7433
Mailing Address - Country:US
Mailing Address - Phone:812-637-2177
Mailing Address - Fax:
Practice Address - Street 1:6863 KERN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-3359
Practice Address - Country:US
Practice Address - Phone:513-353-4478
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 278713163WG0600X
OHRN 278713163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WG0600XNursing Service ProvidersRegistered NurseGerontology
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2143013Medicaid