Individual
MANDY FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1207 HILLSBORO AVE, CHAMPLIN, MN 55316-1913
(612) 747-3014
Mailing address
1207 HILLSBORO AVE, CHAMPLIN, MN 55316-1913
(612) 747-3014
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
651080
MN
Other
Enumeration date
07/20/2026
Last updated
07/20/2026
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