1699931493 NPI number — MR. MICHAEL K FRIZELLE FNP

Table of content: MR. MICHAEL K FRIZELLE FNP (NPI 1699931493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699931493 NPI number — MR. MICHAEL K FRIZELLE FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIZELLE
Provider First Name:
MICHAEL
Provider Middle Name:
K
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
M

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:
1699931493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8875 ELLSWORTH CT NE
Provider Second Line Business Mailing Address:
503
Provider Business Mailing Address City Name:
LACEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98516-3883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-440-3578
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 WAINWRIGHT DR VA MEDICAL CENTER
Provider Second Line Business Practice Location Address:
JONATHAN M WAINWRIGHT MEMORIAL
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-9814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-440-3578
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2008

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:  2962202 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 60101140 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 737610 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 200843205RN , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 60101140 . This is a "VETERAN ADMIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 737610 . This is a "PRIVATE PRACTICE ONLY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2962202 . This is a "MILITARY PRACTICE ONLY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 200843205RN . This is a "VETERAN ADMIN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 103492200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".