Individual
BEVERLY FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
101 ELM AVE SE, ROANOKE, VA 24013-2222
(540) 958-9912
Mailing address
3613 OAKLAWN AVE NW, ROANOKE, VA 24012-2439
(734) 709-4872
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0001279107
VA
163W00000X
Registered Nurse
4704271193
MI
Other
Enumeration date
07/27/2024
Last updated
07/27/2024
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