| Doctor Name: | MR. NICHOLAS HENRY FREDERIKSEN |
| NPI Number: | 1013319334 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APRN,CNP |
| License Number: | R41352 |
| Business Practice Address: | 3000 32nd Ave S Fargo, ND - 581036132 |
| Business Phone Number: | 7013648000 |
| Business Fax Number: | 7013648078 |
| Mailing Address: | Po Box 6001, FARGO |
| State: | ND |
| Postal Code: | 581086001 |
| Phone Number: | 7013648000 |
| Fax Number: | 7013648078 |
| NPI Enumeration Date: | 09/17/2014 |
| NPI Last Update Date: | 12/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | R41352 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ND |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |