Provider Demographics
NPI:1871926873
Name:FREDERICK, AMY LEAH (MIDWIFE)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEAH
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9807 FOXTON PL
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-9250
Mailing Address - Country:US
Mailing Address - Phone:540-898-7094
Mailing Address - Fax:
Practice Address - Street 1:4604 SPOTSYLVANIA PKWY
Practice Address - Street 2:SUITE #310
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7763
Practice Address - Country:US
Practice Address - Phone:540-710-1700
Practice Address - Fax:540-710-1800
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2015-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170677176B00000X
VA0001165857163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse