Healthcare Provider Details

I. General information

NPI: 1679877476
Provider Name (Legal Business Name): ANGELA D FRIETZE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S TELSHOR BLVD
LAS CRUCES NM
88011-5076
US

IV. Provider business mailing address

PO BOX 1908
CLOUDCROFT NM
88317-1908
US

V. Phone/Fax

Practice location:
  • Phone: 575-642-8400
  • Fax:
Mailing address:
  • Phone: 605-413-3795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01162
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: