Marcia Lynn Fredericks, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

454498-1 Issued in NY

Practice address

1663 East 17TH Street
Brooklyn, NY 11229-1259

Phone

(718) 998-0200

NPI assigned

Jan 4, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294099200000",
    "number": "1649574773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1663 EAST 17TH STREET",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291259",
            "telephone_number": "718-998-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1663 EAST 17TH STREET",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291259",
            "telephone_number": "718-998-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "MARCIA",
        "middle_name": "LYNN",
        "name_prefix": "Miss",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-04",
        "last_updated": "2011-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "454498",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "454498-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Jwanza Frederick
• Shara Joanne Frederick, CM,LM,MS
• Arlene Lucille Fredericks, ACNP-BC
• Dale Fredericks
• Inna Fredericks
• Winnet Fredericks
• Malissa Frederique, DDS
• Anielle M Fredman, PHD
• Peter Jay Fredman, MD
• Free Mvmnt

• Registered Nurse in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.