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NPI Code Detail

MEDICARE: SUZANNE LOUISE FRIESEN RD

MEDICARE: SUZANNE LOUISE FRIESEN RD
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
1133V00000XRegistered Dietitian945KS
2133V00000XRegistered Dietitian2008012074MO

General Provider Information

NPI Number : 1790940039
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUZANNE LOUISE FRIESEN RD
Provider Business Mailing Address
First Line : 5578 CRESTWOOD DR
Second Line :
City : KANSAS CITY
State : MO
Zip : 64110-2724
Country : US
Telephone Number : 816-561-7723
Fax Number :
Provider Business Practice Location Address
First Line : 5578 CRESTWOOD DR
Second Line :
City : KANSAS CITY
State : MO
Zip : 64110-2724
Country : US
Telephone Number : 816-561-7723
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2008
Last Update Date : 07/25/2008

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Directions to “ SUZANNE LOUISE FRIESEN RD” Practice Location

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