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General NPI Number Information
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NPI Number | 1144046301
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Entity Type | Individual
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Provider Name | ZACHARY FRIBERG NP
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Gender | Male
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 660 E FRANKLIN RD STE 140
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City | MERIDIAN
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State | ID
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Zip | 83642-2914
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Country | US
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Telephone | 208-992-2672
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Fax | 877-569-2323
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Provider Business Mailing Address
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Address Line | 660 E FRANKLIN RD STE 140
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City | MERIDIAN
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State | ID
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Zip | 83642-2914
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Country | US
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Telephone | 208-992-2672
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 10036869
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1071540
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License Number State | ID
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