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Larry Fredericks
NPI 1700473550 · on the registry since 2020 · sole proprietor
Practice
- Address
- 242 N Oakland Ave
Nappanee, IN 46550 - Phone
- (574) 773-7873
- Fax
- (574) 773-3673
- Organisation at this address
- Martin'S Supermarkets Of Nappanee Llc
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 3
Registry record
- Primary taxonomy
- 183500000X
183500000X
- Licence states on file
- IN
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2020-12-28
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Indiana