Provider Demographics
NPI:1902507536
Name:FREDERICK, AMY DIAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DIAN
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1625 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1226
Mailing Address - Country:US
Mailing Address - Phone:620-728-0923
Mailing Address - Fax:620-728-0823
Practice Address - Street 1:1625 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1226
Practice Address - Country:US
Practice Address - Phone:620-728-0923
Practice Address - Fax:620-728-0823
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1385666072163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health