Healthcare Provider Details

I. General information

NPI: 1245676261
Provider Name (Legal Business Name): ROSE MARY FRIES NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 S ALAMEDA ST
CORPUS CHRISTI TX
78411-1721
US

IV. Provider business mailing address

7609 SAUVE TERRE
CORPUS CHRISTI TX
78414-6178
US

V. Phone/Fax

Practice location:
  • Phone: 361-694-5000
  • Fax:
Mailing address:
  • Phone: 361-779-8361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number554433
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: