Healthcare Provider Details

I. General information

NPI: 1629303771
Provider Name (Legal Business Name): HOLLY MARIE FRIESEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N RIVER ST
HOT SPRINGS SD
57747-1654
US

IV. Provider business mailing address

105 N RIVER ST
HOT SPRINGS SD
57747-1654
US

V. Phone/Fax

Practice location:
  • Phone: 605-745-5188
  • Fax: 605-745-3039
Mailing address:
  • Phone: 605-745-5188
  • Fax: 605-745-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCP000575
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: