Individual
ANDREA FREDERIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
320 AVON ST, PHILADELPHIA, PA 19116-3208
(718) 340-8482
Mailing address
320 AVON ST, PHILADELPHIA, PA 19116-3208
(718) 340-8482
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN751098
PA
163WG0000X
General Practice Registered Nurse
RN751098
PA
Other
Enumeration date
04/20/2023
Last updated
04/20/2023
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