Individual
MRS. BONITA L FREDERICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1177 SUMNER RD, DARIEN CENTER, NY 14040-9797
(585) 547-9367
Mailing address
1177 SUMNER RD, DARIEN CENTER, NY 14040-9797
(585) 547-9367
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2677331
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02705966
—
NY
Enumeration date
03/25/2008
Last updated
03/25/2008
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