Provider Demographics
NPI:1689134884
Name:FREDETTE, CATHLEEN ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:ANNE
Last Name:FREDETTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MIDDLE RD LOT 4
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5991
Mailing Address - Country:US
Mailing Address - Phone:315-806-5013
Mailing Address - Fax:
Practice Address - Street 1:205 MIDDLE RD LOT 4
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-5991
Practice Address - Country:US
Practice Address - Phone:315-806-5013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295519164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse