Healthcare Provider Details

I. General information

NPI: 1720972102
Provider Name (Legal Business Name): MARY FRIED RN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 LINFIELD DR
DURHAM NC
27701-1231
US

IV. Provider business mailing address

631 LINFIELD DR
DURHAM NC
27701-1231
US

V. Phone/Fax

Practice location:
  • Phone: 925-528-9499
  • Fax:
Mailing address:
  • Phone: 925-528-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number362246
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: