Healthcare Provider Details

I. General information

NPI: 1730111352
Provider Name (Legal Business Name): CHRISTINA FREDERICKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PL
POUGHKEEPSIE NY
12601-3947
US

IV. Provider business mailing address

1989 ROUTE 52 STE 2
HOPEWELL JUNCTION NY
12533-3533
US

V. Phone/Fax

Practice location:
  • Phone: 845-483-6217
  • Fax: 845-483-6108
Mailing address:
  • Phone: 845-765-2404
  • Fax: 845-765-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303438
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: