1215947312 NPI number — MRS. MARNELL JUNE FRIZZELL APRN FNP

Table of content: MRS. MARNELL JUNE FRIZZELL APRN FNP (NPI 1215947312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215947312 NPI number — MRS. MARNELL JUNE FRIZZELL APRN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIZZELL
Provider First Name:
MARNELL
Provider Middle Name:
JUNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUILENBURG
Provider Other First Name:
MARNELL
Provider Other Middle Name:
JUNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215947312
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:
PO BOX 367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAPWAI
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83540-0367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-843-2271
Provider Business Mailing Address Fax Number:
208-843-2658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 THIRD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAMIAH
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-843-2271
Provider Business Practice Location Address Fax Number:
208-843-2658
Provider Enumeration Date:
08/09/2006

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: 363LF0000X , with the licence number:  N28225 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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