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General NPI Number Information
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NPI Number | 1093256612
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Entity Type | Individual
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Provider Name | DANIELLE NICOLE FRIES AGNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6812 STATE ROUTE 162 STE 200
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City | MARYVILLE
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State | IL
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Zip | 62062-8562
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Country | US
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Telephone | 618-288-0900
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Fax | 618-288-0909
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Provider Business Mailing Address
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Address Line | 12855 N 40 DR STE 375
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8657
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Country | US
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Telephone | 314-567-6071
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Fax | 618-288-0909
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2017007578
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209015785
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License Number State | IL
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