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Individual
JAMES FREDERICKSON
Active
Individual
JAMES FREDERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
F6364559441101
WI
390200000X
Student in an Organized Health Care Education/Training Program
F6364559441101
WI
Other
Enumeration date
02/10/2017
Last updated
07/02/2020
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