Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4718 | SD |
N | 207VX0201X | Gynecologic Oncologist | 4718 | SD |
NPI | 1144251786 |
---|---|
Provider Name | Helen L Frederickson |
First Address | Rapid City, SD 57709-3450 |
Second Address | Rapid City, SD 57701-7375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 28/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6200862 | (05) | SD |
A57982 | (02) |