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General NPI Number Information
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NPI Number | 1184001745
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Entity Type | Organization
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Legal Business Name | LORAIN COUNTY CORRECTIONAL INSTITUTION
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 1421 BRADLEY RD
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City | WESTLAKE
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State | OH
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Zip | 44145-1721
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Country | US
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Telephone | 440-899-4937
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Fax |
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Provider Business Mailing Address
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Address Line | 1421 BRADLEY RD
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City | WESTLAKE
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State | OH
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Zip | 44145-1721
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Country | US
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Telephone | 440-899-4937
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF MEDICINE
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Name | DR. JOHN FRIESEN
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Credential | MD
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Telephone | 440-748-1049
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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 | 16327-NP
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License Number State | OH
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