Provider Demographics
NPI:1760163661
Name:FREDRIKSSON, HAILEY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:ANN
Last Name:FREDRIKSSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13460 N 94TH DR STE J1
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4264
Mailing Address - Country:US
Mailing Address - Phone:238-768-8166
Mailing Address - Fax:623-298-0168
Practice Address - Street 1:13460 N 94TH DR STE J1
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4264
Practice Address - Country:US
Practice Address - Phone:238-768-8166
Practice Address - Fax:623-298-0168
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant