Healthcare Provider Details

I. General information

NPI: 1457348021
Provider Name (Legal Business Name): JUDY FREDETTE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 GREEN ST
GARDNER MA
01440-1336
US

IV. Provider business mailing address

242 GREEN ST
GARDNER MA
01440-1336
US

V. Phone/Fax

Practice location:
  • Phone: 978-630-6545
  • Fax:
Mailing address:
  • Phone: 978-630-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number151893
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: