MEDICARE: LAWRENCE EDMUND FRIESTAD CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	100035	NE

General Provider Information

NPI Number	:	1003889312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE EDMUND FRIESTAD CRNA

Provider Business Mailing Address
First Line	:	PO BOX 388
Second Line	:
City	:	NEWTON
State	:	KS
Zip	:	67114-0388
Country	:	US
Telephone Number	:	316-281-3700
Fax Number	:	316-282-4322

Provider Business Practice Location Address
First Line	:	1301 EAST H ST
Second Line	:
City	:	MCCOOK
State	:	NE
Zip	:	69001-1328
Country	:	US
Telephone Number	:	308-345-2650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/08/2007

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