| NPI | 1609004910 |
|---|---|
| Former Name | ANGELA MARIE FREDERICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 54175) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NM 992) |
| 261QV0200X Clinic/Center, VA (Licence: NM 54175) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2022-03-11 |