| Doctor Name: | MRS. ANGIE MARIE FREDERIC |
| NPI Number: | 1629155080 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD, LD, CDE |
| License Number: | 593 |
| Business Practice Address: | 525 N Santiam Hwy Lebanon, OR - 973554363 |
| Business Phone Number: | 5414517197 |
| Business Fax Number: | 5414516304 |
| Mailing Address: | 213 Violet St, LEBANON |
| State: | OR |
| Postal Code: | 973551570 |
| Phone Number: | 5414514335 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 593 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |