MEDICARE: OLIVIA LYNN FRICKE CNM, APRN

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	367A00000X	Advanced Practice Midwife	472	MN

General Provider Information

NPI Number	:	1033871660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA LYNN FRICKE CNM, APRN

Provider Business Mailing Address
First Line	:	1919 NICOLLET AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3747
Country	:	US
Telephone Number	:	719-580-9134
Fax Number	:	612-236-4745

Provider Business Practice Location Address
First Line	:	1919 NICOLLET AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3747
Country	:	US
Telephone Number	:	719-580-9134
Fax Number	:	612-236-4745

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

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	06/27/2023

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