Individual
MRS. BROOKE LEIGH FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LRD, CSG
Contact information
Practice address
1200 ROBERTS AVE NE, COOPERSTOWN, ND 58425-7101
(701) 797-2221
Mailing address
80 COUNTY ROAD 19, COOPERSTOWN, ND 58425-9168
(701) 361-7154
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
669
ND
Other
Enumeration date
09/18/2009
Last updated
09/18/2009
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