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Individual

AMY D FREDRICKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
L.M.P.

Contact information

Practice address
1208 S 216TH ST, APT 103D, DES MOINES, WA 98198-8363
(907) 738-2116
Mailing address
1208 S 216TH ST, APT 103D, DES MOINES, WA 98198-8363
(907) 738-2116

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA60722244
WA

Other

Enumeration date
02/13/2017
Last updated
02/13/2017
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