MEDICARE: MRS. KELLY MARIE FRIDRICH NP-C

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	363LF0000X	Family Nurse Practitioner	14979	OH

General Provider Information

NPI Number	:	1275969545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY MARIE FRIDRICH NP-C

Provider Business Mailing Address
First Line	:	963 CAHOON RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1229
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35105 CENTER RIDGE RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-3081
Country	:	US
Telephone Number	:	440-327-1050
Fax Number	:

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

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	06/20/2017

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