| Lisa Gay Fredrickson, FNP | |
|
205 South St, Fort Bragg, CA 95437-5540 | |
| (707) 961-1251 | |
| Not Available |
| Full Name | Lisa Gay Fredrickson |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Family |
| Location | 205 South St, Fort Bragg, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932533924 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163W00000X | Registered Nurse | 806740 (California) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 95026356 (California) | Primary |
| Entity Name | Mendocino Coast Clinics, Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1609595404 PECOS PAC ID: 5991619157 Enrollment ID: O20050512001033 |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Gay Fredrickson, FNP 860 E Laurel St, Fort Bragg, CA 95437-3817 Ph: (707) 972-0884 | Lisa Gay Fredrickson, FNP 205 South St, Fort Bragg, CA 95437-5540 Ph: (707) 961-1251 |
Sasha Graham, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 721 River Drive, Suite A, Fort Bragg, CA 95437 Phone: 707-964-7241 Fax: 707-964-1192 | |
Ms. Ann Kathleen Jamgochian, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 205 South St, Fort Bragg, CA 95437 Phone: 707-964-1251 | |
Mrs. Michele Marie Tellier, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 721 River Drive, Suite A, Fort Bragg, CA 95437 Phone: 707-961-4631 Fax: 707-964-1192 | |
Ms. Susan Jean Klarquist, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 205 South St, Fort Bragg, CA 95437 Phone: 707-964-1251 Fax: 707-961-2722 | |
Linnea Marie Matthews, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 205 South St, Fort Bragg, CA 95437 Phone: 707-964-1251 Fax: 707-961-2722 | |
Miss Joanne Louise Patterson, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 205 South St, Fort Bragg, CA 95437 Phone: 707-964-1251 | |
Suzanne H. Hewitt, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 721 River Dr., Fort Bragg, CA 95437 Phone: 707-961-4631 Fax: 707-961-4631 |