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General NPI Number Information
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NPI Number | 1023139821
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Entity Type | Individual
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Provider Name | JENNIFER ROBYN FRIBERG N.P.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 114 N WASHINGTON ST
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City | BOURBON
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State | IN
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Zip | 46504-1623
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Country | US
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Telephone | 574-335-7850
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Fax | 574-335-0755
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Provider Business Mailing Address
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Address Line | 5215 HOLY CROSS PKWY
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City | MISHAWAKA
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State | IN
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Zip | 46545-1469
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71002345
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License Number State | IN
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