Provider Demographics
NPI:1689410748
Name:FREY, MICHAELA K (APRN)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:K
Last Name:FREY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:K
Other - Last Name:ZUMBAHLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-0372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 WOODDELL WAY STE B
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-1014
Practice Address - Country:US
Practice Address - Phone:217-238-3000
Practice Address - Fax:217-238-3008
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.029713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily