Provider Demographics
NPI:1801494083
Name:FREDRICKSON, EMILY ELIZABETH (RN, CPNP-PC)
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:HANSON
Mailing Address - State:MA
Mailing Address - Zip Code:02341-1314
Mailing Address - Country:US
Mailing Address - Phone:781-640-4296
Mailing Address - Fax:
Practice Address - Street 1:21 BROOK ST
Practice Address - Street 2:
Practice Address - City:HANSON
Practice Address - State:MA
Practice Address - Zip Code:02341-1314
Practice Address - Country:US
Practice Address - Phone:781-640-4296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-11
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2335340163W00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse