Individual
LISELLE FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1160 HICKS PL, NORTH BALDWIN, NY 11510-1116
(516) 765-1449
Mailing address
1160 HICKS PL, NORTH BALDWIN, NY 11510-1116
(516) 765-1449
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
768654-1
NY
Other
Enumeration date
03/02/2020
Last updated
03/02/2020
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