Provider Demographics
NPI:1215666276
Name:FREDRICK, AERIAL ELEESE RHODENIA
Entity type:Individual
Prefix:
First Name:AERIAL
Middle Name:ELEESE RHODENIA
Last Name:FREDRICK
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 1:7809 LOCRIS CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4433
Mailing Address - Country:US
Mailing Address - Phone:240-320-4113
Mailing Address - Fax:
Practice Address - Street 1:4410 LIVINGSTON RD SE APT B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2942
Practice Address - Country:US
Practice Address - Phone:202-373-1397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant