Provider Demographics
NPI:1619605045
Name:MCINTOSH, FREDA HERNA-HAYES
Entity Type:Individual
Prefix:
First Name:FREDA
Middle Name:HERNA-HAYES
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10952 QUINCY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2700
Mailing Address - Country:US
Mailing Address - Phone:612-518-8071
Mailing Address - Fax:
Practice Address - Street 1:10952 QUINCY BLVD NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-2700
Practice Address - Country:US
Practice Address - Phone:612-518-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health