Provider Demographics
NPI:1043018773
Name:FRERICHS, JOHN LEE
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LEE
Last Name:FRERICHS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-2907
Mailing Address - Country:US
Mailing Address - Phone:308-390-8228
Mailing Address - Fax:
Practice Address - Street 1:1715 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-2907
Practice Address - Country:US
Practice Address - Phone:308-390-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist