Healthcare Provider Details

I. General information

NPI: 1588641484
Provider Name (Legal Business Name): REBECCA S FRISCH PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 E 1ST ST
GRUNDY CENTER IA
50638-2046
US

IV. Provider business mailing address

606 E 1ST ST
GRUNDY CENTER IA
50638-2046
US

V. Phone/Fax

Practice location:
  • Phone: 319-824-6945
  • Fax: 319-824-6947
Mailing address:
  • Phone: 319-824-6945
  • Fax: 319-824-6947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001271
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: