Provider Demographics
NPI:1902363336
Name:FREDREGILL, ERICA (PNP-PC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:FREDREGILL
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4613
Mailing Address - Country:US
Mailing Address - Phone:303-618-6792
Mailing Address - Fax:
Practice Address - Street 1:9141 GRANT ST STE 115
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4318
Practice Address - Country:US
Practice Address - Phone:303-920-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994036-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics