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General NPI Number Information
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NPI Number | 1790312171
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Entity Type | Organization
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Legal Business Name | SEQUOIA INTEGRATIVE MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 1746 PAUL DR
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City | KAUKAUNA
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State | WI
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Zip | 54130-3014
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Country | US
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Telephone | 920-422-7402
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 411
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City | RIVERSIDE
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State | IL
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Zip | 60546-6411
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Country | US
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Telephone | 920-422-7402
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY K FRIESS
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Credential | APNP
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Telephone | 920-422-7402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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