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NPI Code Detail

MEDICARE: LISA FRIEBOHLE

MEDICARE: LISA FRIEBOHLE
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
1363LA2200XAdult Health Nurse Practitioner277001893IL

General Provider Information

NPI Number : 1629466743
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA FRIEBOHLE
Provider Business Mailing Address
First Line : 1120 E WAR MEMORIAL DR
Second Line :
City : PEORIA HEIGHTS
State : IL
Zip : 61616-7757
Country : US
Telephone Number : 309-685-4411
Fax Number : 309-685-3648
Provider Business Practice Location Address
First Line : 1120 E WAR MEMORIAL DR
Second Line :
City : PEORIA HEIGHTS
State : IL
Zip : 61616-7757
Country : US
Telephone Number : 309-685-4411
Fax Number : 309-685-3648
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2014
Last Update Date : 01/06/2025

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Directions to “ LISA FRIEBOHLE ” Practice Location

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