Provider Demographics
NPI:1982124509
Name:FREDRICKSON, CATHERINE (SFA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:SFA
Other - Prefix:
Other - First Name:CATHEY
Other - Middle Name:
Other - Last Name:FREDRICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SFA
Mailing Address - Street 1:51312 W DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-3554
Mailing Address - Country:US
Mailing Address - Phone:205-840-7509
Mailing Address - Fax:
Practice Address - Street 1:51312 W DEER RUN RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-3554
Practice Address - Country:US
Practice Address - Phone:205-840-7509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-24
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical