Provider Demographics
NPI:1356645006
Name:VANDEGAER, FRIEDA GODELIEVE (RN, PMH-CNS, BC)
Entity Type:Individual
Prefix:MS
First Name:FRIEDA
Middle Name:GODELIEVE
Last Name:VANDEGAER
Suffix:
Gender:F
Credentials:RN, PMH-CNS, BC
Other - Prefix:MS
Other - First Name:FRIEDA
Other - Middle Name:GODELIEVE
Other - Last Name:VANDEGAER-CANNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:5525 RESEARCH PARK DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:215-443-3850
Mailing Address - Fax:215-443-3963
Practice Address - Street 1:10000 ANNS CHOICE WAY
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-3527
Practice Address - Country:US
Practice Address - Phone:215-443-3850
Practice Address - Fax:215-443-3963
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN251626L163W00000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse