Healthcare Provider Details

I. General information

NPI: 1871916965
Provider Name (Legal Business Name): JULIE FREDETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10745 STATE HIGHWAY 27
HOFFMAN MN
56339-4005
US

IV. Provider business mailing address

PO BOX 558
HOFFMAN MN
56339-0558
US

V. Phone/Fax

Practice location:
  • Phone: 320-986-2211
  • Fax:
Mailing address:
  • Phone: 320-986-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: