Provider Demographics
NPI:1770963977
Name:FREDRICKSON, LINDSAY (RN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:MISS
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:HIATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:844 OLD TUNNEL RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-8524
Mailing Address - Country:US
Mailing Address - Phone:530-274-9762
Mailing Address - Fax:866-329-5646
Practice Address - Street 1:844 OLD TUNNEL RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-8524
Practice Address - Country:US
Practice Address - Phone:530-274-9762
Practice Address - Fax:866-329-5646
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201505278RN163W00000X
OR202010177NP-PP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse