MEDICARE: LISA FRIEDHABER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	RN.1647512	CO

General Provider Information

NPI Number	:	1821744012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA FRIEDHABER RN

Provider Business Mailing Address
First Line	:	1092 ADAMS ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-3414
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1092 ADAMS ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-3414
Country	:	US
Telephone Number	:	724-679-1187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2022
Last Update Date	:	02/25/2022

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