Provider Demographics
NPI:1205490992
Name:FRUGE, CAROLYN L MENDIOLA (MSN AGNP)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:L MENDIOLA
Last Name:FRUGE
Suffix:
Gender:F
Credentials:MSN AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7358
Mailing Address - Street 2:
Mailing Address - City:AGAT
Mailing Address - State:GU
Mailing Address - Zip Code:96928-0358
Mailing Address - Country:US
Mailing Address - Phone:671-487-1927
Mailing Address - Fax:
Practice Address - Street 1:1244 N MARINE CORPS DR
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-4308
Practice Address - Country:US
Practice Address - Phone:671-647-8262
Practice Address - Fax:671-647-5252
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUNP-0198363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology