Provider Demographics
NPI:1538428222
Name:FRICKE, LEANNE
Entity type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:
Last Name:FRICKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WHITE GATE DR APT K
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5064
Mailing Address - Country:US
Mailing Address - Phone:845-632-1850
Mailing Address - Fax:
Practice Address - Street 1:10 WHITE GATE DR APT K
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-5064
Practice Address - Country:US
Practice Address - Phone:845-632-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist