Individual
CLARENCE FREDERIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
13 CLEVELAND ST, VALLEY STREAM, NY 11580-6003
(516) 823-0739
Mailing address
15 CHURCH ST, GREAT NECK, NY 11023-1126
(347) 546-5645
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
311641
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
311641
LPN
NY
Enumeration date
11/07/2012
Last updated
11/07/2012
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