Individual
CHRISTINA FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
355 W MAIN ST STE 425, MALONE, NY 12953-1826
(518) 481-1529
Mailing address
8425 US HIGHWAY 11, POTSDAM, NY 13676-3235
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
674341
NY
Other
Enumeration date
07/08/2016
Last updated
07/08/2016
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