1750374799 NPI number — MRS. ANDREA LYNN FRIESEN RN, MSN, ARNP

Table of content: MRS. ANDREA LYNN FRIESEN RN, MSN, ARNP (NPI 1750374799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750374799 NPI number — MRS. ANDREA LYNN FRIESEN RN, MSN, ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIESEN
Provider First Name:
ANDREA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROCKWELL
Provider Other First Name:
ANDREA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750374799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3308 214TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98036-6841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-774-8536
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 SHELBY RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98087-3599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-742-9119
Provider Business Practice Location Address Fax Number:
425-787-1055
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN00111921 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LF0000X , with the licence number: AP30005339 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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