Individual
MRS. ANGIE MARIE FREDERIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD, CDE
Contact information
Practice address
525 N SANTIAM HWY, LEBANON, OR 97355-4363
(541) 451-7197
(541) 451-6304
Mailing address
213 VIOLET ST, LEBANON, OR 97355-1570
(541) 451-4335
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
593
OR
Other
Enumeration date
11/01/2006
Last updated
07/09/2007
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