Basic Information
| Provider Information | |||||||||
| NPI: | 1447307988 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREDD | ||||||||
| FirstName: | DIANNE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 POWERHOUSE RD | ||||||||
| Address2: | 3 FL | ||||||||
| City: | ROSLYN HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115771324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169453000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10201 66TH RD | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113752029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188304091 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 212722 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.