Provider Demographics
NPI:1508177809
Name:FREDERICK, ELIZABETH LYNNE (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LYNNE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12502 OCEAN REEF DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-2726
Mailing Address - Country:US
Mailing Address - Phone:443-614-2044
Mailing Address - Fax:
Practice Address - Street 1:33664 BAYVIEW MEDICAL DR UNIT 2
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1687
Practice Address - Country:US
Practice Address - Phone:302-645-5650
Practice Address - Fax:302-645-5481
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELZ-0000118363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care