Individual
EMILY MARIA FREDERICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
801 BROADWAY, CHESTERTON, IN 46304-2230
(219) 763-8112
Mailing address
6050 STERLING CREEK RD, PORTAGE, IN 46368-7752
(219) 763-8112
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
71014132A
IN
Other
Enumeration date
07/21/2023
Last updated
07/21/2023
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