Provider Demographics
NPI:1366458424
Name:FREDERICKS, ANNMARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:ANNMARIE
Middle Name:
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ANNMARIE
Other - Middle Name:
Other - Last Name:FREDERICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, MPA/H
Mailing Address - Street 1:32 DALTON RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1013
Mailing Address - Country:US
Mailing Address - Phone:774-826-2889
Mailing Address - Fax:774-826-2014
Practice Address - Street 1:940 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5596
Practice Address - Country:US
Practice Address - Phone:774-826-2889
Practice Address - Fax:774-826-2014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173013363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health