Provider Demographics
NPI:1245486737
Name:FREDERICK, SUSAN MARIA (FNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIA
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF ROCHESTER STRONG MEM
Mailing Address - Street 2:601 ELMWOOD AVENUE BOX 619-28
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-3335
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF ROCHESTER STRONG MEM
Practice Address - Street 2:601 ELMWOOD AVENUE BOX 619-28
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-273-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33 333028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily