Healthcare Provider Details

I. General information

NPI: 1427186238
Provider Name (Legal Business Name): LETA ANN FRIEDT R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 4TH AVENUE SW
ALBANY OR
97321
US

IV. Provider business mailing address

4437 CHERYL CT NE
SALEM OR
97305-2208
US

V. Phone/Fax

Practice location:
  • Phone: 541-967-3888
  • Fax: 541-924-6911
Mailing address:
  • Phone: 503-390-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: