Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 47118 | KY |
Y | 207VX0201X | Gynecologic Oncologist | 31800 | NE |
NPI | 1295053569 |
---|---|
Provider Name | Dr. Tricia Irene Fredericks |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2010 |
Last Update Date | 07/07/2019 |