Provider Demographics
NPI:1255140745
Name:MOKAYA, FREDRICK K
Entity type:Individual
Prefix:
First Name:FREDRICK
Middle Name:K
Last Name:MOKAYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 SUNFLOWER WAY NW
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352-6000
Mailing Address - Country:US
Mailing Address - Phone:952-686-1816
Mailing Address - Fax:
Practice Address - Street 1:3112 SUNFLOWER WAY NORTHWEST
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-5989
Practice Address - Country:US
Practice Address - Phone:952-686-1816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2513578163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health