Provider Demographics
NPI:1962712042
Name:FRICKER, WALTER RAYMOND JR
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:RAYMOND
Last Name:FRICKER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 DIAMOND CT
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-4070
Mailing Address - Country:US
Mailing Address - Phone:845-246-1272
Mailing Address - Fax:
Practice Address - Street 1:39 DIAMOND CT
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-4070
Practice Address - Country:US
Practice Address - Phone:845-246-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4922481163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health