Provider Demographics
NPI:1912695123
Name:FREDD, NICHOLAS (RN, BSN)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:FREDD
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12209 GRANNIS RD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-4303
Mailing Address - Country:US
Mailing Address - Phone:216-308-5911
Mailing Address - Fax:
Practice Address - Street 1:12209 GRANNIS RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-4303
Practice Address - Country:US
Practice Address - Phone:216-308-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH443765163WN0300X, 163W00000X, 163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WN0300XNursing Service ProvidersRegistered NurseNephrology
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis