Doctor Name: | MRS. AMANDA FREDERICK |
NPI Number: | 1013306596 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN, FNP |
License Number: | 2007031264 |
Business Practice Address: | 207 E Pitman St O Fallon, MO - 633662620 |
Business Phone Number: | 6368751140 |
Business Fax Number: | |
Mailing Address: | 207 E Pitman St, O FALLON |
State: | MO |
Postal Code: | 633662620 |
Phone Number: | 6368751140 |
Fax Number: | |
NPI Enumeration Date: | 01/21/2015 |
NPI Last Update Date: | 01/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2007031264 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |