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General NPI Number Information
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NPI Number | 1710469481
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Entity Type | Individual
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Provider Name | NICHOLAS A FREDETTE DNP
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Gender | Male
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 28 S. WILLIAMS ST.
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City | BURLINGTON
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State | VT
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Zip | 05401
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Country | US
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Telephone | 802-558-7595
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Fax |
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Provider Business Mailing Address
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Address Line | 28 S WILLIAMS ST
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City | BURLINGTON
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State | VT
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Zip | 05401
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Country | US
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Telephone |
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Fax |
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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 | 101.0134186
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 101.0134186
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 101.0134186
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License Number State | VT
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