Healthcare Provider Details

I. General information

NPI: 1588584445
Provider Name (Legal Business Name): AMY L FRIES RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WAINWRIGHT DR
WALLA WALLA WA
99362-3975
US

IV. Provider business mailing address

77 WAINWRIGHT DR
WALLA WALLA WA
99362-3975
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-5200
  • Fax:
Mailing address:
  • Phone: 509-525-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201240687RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.RN.00160128
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: