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General NPI Number Information
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NPI Number | 1366458424
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Entity Type | Individual
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Provider Name | ANNMARIE FREDERICKS N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 940 BELMONT ST
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City | BROCKTON
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State | MA
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Zip | 02301-5596
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Country | US
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Telephone | 774-826-2889
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Fax | 774-826-2014
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Provider Business Mailing Address
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Address Line | 32 DALTON RD
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City | HOLBROOK
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State | MA
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Zip | 02343-1013
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Country | US
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Telephone | 774-826-2889
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Fax | 774-826-2014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 173013
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License Number State | MA
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