Individual
ANNIE FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDT
Contact information
Practice address
11703 E SPRAGUE AVE STE C3, SPOKANE VALLEY, WA 99206-6129
(509) 921-6560
Mailing address
PO BOX 1576, NEWPORT, WA 99156-1576
(509) 921-6560
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI00000556
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00719636
ADA NUMBER
WA
01
—
8260051
PROVIDER NUMBER
WA
05
—
9051731
—
WA
01
—
DI00000556
WA CERTIFICATION NUMBER
WA
Enumeration date
05/20/2008
Last updated
05/20/2008
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