| Lance R Fredrickson, CRNA | |
|
801 E Wheeler Rd, Moses Lake, WA 98837-1820 | |
| (509) 765-5606 | |
| (509) 764-3244 |
| Full Name | Lance R Fredrickson |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 801 E Wheeler Rd, Moses Lake, Washington |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659522308 | NPI | - | NPPES |
| 2307808 | Medicaid | WA | |
| 3504375-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | AP120956 (Texas) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | AP61610317 (Washington) | Primary |
| Entity Name | Austin Anesthesiology Group Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1598724304 PECOS PAC ID: 0547256497 Enrollment ID: O20040424000086 |
| Entity Name | Mch Professional Care Hospital Based |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1447547773 PECOS PAC ID: 1557535127 Enrollment ID: O20111116000437 |
| Entity Name | Youngs Professional Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1922178599 PECOS PAC ID: 2163524992 Enrollment ID: O20120104000614 |
| Entity Name | Emergenchealth Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1467970897 PECOS PAC ID: 1355606641 Enrollment ID: O20180608000439 |
| Mailing Address | Practice Location Address |
|---|---|
| Lance R Fredrickson, CRNA 660 S Coolidge St, Moses Lake, WA 98837-1872 Ph: (509) 793-9715 | Lance R Fredrickson, CRNA 801 E Wheeler Rd, Moses Lake, WA 98837-1820 Ph: (509) 765-5606 |
Ms. Stephanie Kay Moore, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 801 E Wheeler Rd, Moses Lake, WA 98837 Phone: 509-765-5606 | |
Vanessa F Ratcliff, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 801 E Wheeler Rd, Moses Lake, WA 98837 Phone: 509-765-5606 | |
James Kanon Griffitts, Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 801 E Wheeler Rd, Moses Lake, WA 98837 Phone: 509-765-5606 | |
Joshua A. Nunnery, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 801 E Wheeler Rd, Moses Lake, WA 98837 Phone: 509-765-5606 | |
Robert Misasi, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 801 E Wheeler Rd, Moses Lake, WA 98837 Phone: 509-764-5606 | |
Mars Brimhall, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 801 E Wheeler Rd, Moses Lake, WA 98837 Phone: 770-643-5619 | |
Brian N Nordstrom, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 801 E Wheeler Rd, Moses Lake, WA 98837 Phone: 509-765-5606 |