Provider Demographics
NPI:1629554837
Name:FREDETTE, AMANDA L (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:FREDETTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SPRAGUE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:NY
Mailing Address - Zip Code:13112-9743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 SPRAGUE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:NY
Practice Address - Zip Code:13112-9743
Practice Address - Country:US
Practice Address - Phone:315-480-3891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY494249163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy