Provider Demographics
NPI:1710470968
Name:FRANDSEN, EDEN LOUISE (APRN)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:LOUISE
Last Name:FRANDSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:EDEN
Other - Middle Name:LOUISE
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10527 STAGGERING CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5349
Mailing Address - Country:US
Mailing Address - Phone:801-635-4053
Mailing Address - Fax:
Practice Address - Street 1:6735 FM 78 STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1368
Practice Address - Country:US
Practice Address - Phone:210-888-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX912324163W00000X
TX1017810363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX912324OtherSTATE NURSING LICENSE
TX1017810OtherSTATE APRN LICENSE