Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 18293 | CA |
NPI | 1164671178 |
---|---|
Provider Name | Ms. Anne E Fredericks |
First Address | San Francisco, CA 94115-1925 |
Second Address | San Francisco, CA 94115-1925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2008 |
Last Update Date | 11/02/2022 |