Basic Information
| Provider Information | |||||||||
| NPI: | 1205490992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRUGE | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | L. MENDIOLA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN. AGNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7358 | ||||||||
| Address2: | |||||||||
| City: | AGAT | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969280358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6714871927 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1244 N MARINE CORPS DR | ||||||||
| Address2: | |||||||||
| City: | TAMUNING | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969134308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716478262 | ||||||||
| FaxNumber: | 6716475252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2019 | ||||||||
| LastUpdateDate: | 04/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | NP-0198 | GU | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.