Healthcare Provider Details

I. General information

NPI: 1265034508
Provider Name (Legal Business Name): RODGER DALE FRISTAD INTERPRETER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 STATE ROUTE 150 SPC 60
MANSON WA
98831-9060
US

IV. Provider business mailing address

1000 STATE ROUTE 150 SPC 60
MANSON WA
98831-9060
US

V. Phone/Fax

Practice location:
  • Phone: 509-433-8543
  • Fax:
Mailing address:
  • Phone: 509-433-8543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number4582
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberSC12066
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberMC56081
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: