National Provider Identifier
Glenn H Fredenburg
Glenn H Fredenburg is listed in the NPPES registry with a primary specialty of Family Nurse Practitioner in Buffalo, NY and a listed phone number of (518) 335-5097.
Profile Overview
- NPI
- 1679152664
- Provider Type
- Individual
- Primary Specialty
- Family Nurse Practitioner
- Enumeration Date
- April 06, 2021
- Last Updated
- April 27, 2022
Practice Location
- 40 La Riviere Dr Ste 201
- Buffalo, NY 14202-4344
Phone: (518) 335-5097
Mailing Address
- 9467 State Route 9
- Chazy, NY 12921-2043
Specialties
- Family Nurse Practitioner (363LF0000X)
Full Record
- NPI
- 1679152664
- Entity Type
- Individual
- Last Name
- Fredenburg
- First Name
- Glenn
- Middle Name
- H
- Mailing Street Address
- 9467 State Route 9
- Mailing City
- Chazy
- Mailing State
- NY
- Mailing ZIP Code
- 12921-2043
- Mailing Country
- US
- Mailing Phone
- (518) 335-5097
- Practice Street Address
- 40 La Riviere Dr Ste 201
- Practice City
- Buffalo
- Practice State
- NY
- Practice ZIP Code
- 14202-4344
- Practice Country
- US
- Practice Phone
- (518) 335-5097
- Enumeration Date
- April 06, 2021
- Last Updated
- April 27, 2022
- Sex
- Male
- Sole Proprietor
- Yes
- Certification Date
- April 27, 2022
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Family Nurse Practitioner (363LF0000X)