Healthcare Provider Details

I. General information

NPI: 1154636710
Provider Name (Legal Business Name): CHRISTINE R FRIEDRICH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2010
Last Update Date: 04/18/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 NW DONOVAN RD UNIT 3009
LEES SUMMIT MO
64086-4557
US

IV. Provider business mailing address

805 NW DONOVAN RD UNIT 3009
LEES SUMMIT MO
64086-4557
US

V. Phone/Fax

Practice location:
  • Phone: 816-349-0095
  • Fax:
Mailing address:
  • Phone: 816-349-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010012803
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: