Provider Demographics
NPI:1760559280
Name:MEADE, FREDERICA (RN)
Entity Type:Individual
Prefix:
First Name:FREDERICA
Middle Name:
Last Name:MEADE
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 1:3122 GREENE RD
Mailing Address - Street 2:
Mailing Address - City:ERIEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13061-1308
Mailing Address - Country:US
Mailing Address - Phone:315-662-3175
Mailing Address - Fax:
Practice Address - Street 1:3122 GREENE RD
Practice Address - Street 2:
Practice Address - City:ERIEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13061-1308
Practice Address - Country:US
Practice Address - Phone:315-662-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY425526-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01500389Medicaid