Provider Demographics
NPI:1710382908
Name:FREDETTE, JEN (DOULA)
Entity Type:Individual
Prefix:
First Name:JEN
Middle Name:
Last Name:FREDETTE
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 RAILROAD AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBERTON
Mailing Address - State:MT
Mailing Address - Zip Code:59820
Mailing Address - Country:US
Mailing Address - Phone:406-356-6561
Mailing Address - Fax:
Practice Address - Street 1:512 RAILROAD AVENUE
Practice Address - Street 2:
Practice Address - City:ALBERTON
Practice Address - State:MT
Practice Address - Zip Code:59820
Practice Address - Country:US
Practice Address - Phone:406-356-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist