Healthcare Provider Details

I. General information

NPI: 1821379462
Provider Name (Legal Business Name): KATHERINE FRIESE RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 ANNE ST NW # 5678
BEMIDJI MN
56601-6151
US

IV. Provider business mailing address

1705 ANNE ST NW # 5678
BEMIDJI MN
56601-6151
US

V. Phone/Fax

Practice location:
  • Phone: 218-333-4735
  • Fax:
Mailing address:
  • Phone: 218-333-4735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 169158-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: