Healthcare Provider Details

I. General information

NPI: 1811448731
Provider Name (Legal Business Name): STEPHANIE FRIEDMAN DNP, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TRI PARK WAY
APPLETON WI
54914-1658
US

IV. Provider business mailing address

10 TRI-PARK WAY
APPLETON WI
54914-2807
US

V. Phone/Fax

Practice location:
  • Phone: 920-831-0070
  • Fax:
Mailing address:
  • Phone: 920-831-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7090-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: