1649217886 NPI number — MS. STEPHANIE MICHELE FRIESS ANP

Table of content: (NPI 1093490112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649217886 NPI number — MS. STEPHANIE MICHELE FRIESS ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIESS
Provider First Name:
STEPHANIE
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649217886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
945 16TH AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52314-1229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-350-7228
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
713 1ST AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52314-1478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-350-7228
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2006

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: 363L00000X , with the licence number:  ANP463 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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