Provider Demographics
NPI:1912622556
Name:BROTHERS, FREDA MARIE
Entity Type:Individual
Prefix:
First Name:FREDA
Middle Name:MARIE
Last Name:BROTHERS
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 1:36 AUSTIN JAY DR
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26542-9128
Mailing Address - Country:US
Mailing Address - Phone:267-825-2527
Mailing Address - Fax:
Practice Address - Street 1:36 AUSTIN JAY DR
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:WV
Practice Address - Zip Code:26542-9128
Practice Address - Country:US
Practice Address - Phone:267-825-2527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant