| NPI | 1942206586 |
|---|---|
| Former Name | MAMIE D FREDRICKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA00713) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA00713) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2012-03-12 |