Provider Demographics
NPI:1780433409
Name:FREDENBURG, ROBERTA L (RN)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:L
Last Name:FREDENBURG
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:CLINTON COUNTY HEALTH DEPT
Mailing Address - Street 2:133 MARGARET ST
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901
Mailing Address - Country:US
Mailing Address - Phone:518-565-4853
Mailing Address - Fax:
Practice Address - Street 1:CLINTON COUNTY HEALTH DEPT
Practice Address - Street 2:133 MARGARET ST
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-565-4853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3824661163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health