Jordan Fredrickson

NPI #1376382267 in Grover, Missouri

Provider Information

NPI Number: 1376382267
Entity Type: Individual
Name: Jordan Fredrickson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Technician, Other
Enumeration Date: May 21, 2024
Last Updated: May 21, 2024

Practice Location

Address: 2825 WESTRIDGE OAKS CT
City: Grover
State: Missouri
ZIP Code: 63040-1130
Phone: (314) 706-0655

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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