Healthcare Provider Details

I. General information

NPI: 1740122472
Provider Name (Legal Business Name): AIMEE FRENETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 W AZTEC BLVD
AZTEC NM
87410-1818
US

IV. Provider business mailing address

PO BOX 1273
TUPPER LAKE NY
12986-0273
US

V. Phone/Fax

Practice location:
  • Phone: 505-334-6102
  • Fax:
Mailing address:
  • Phone:
  • Fax: 505-334-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number440991
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: