Provider Demographics
NPI:1205954120
Name:FREIDEL, MARY L (CSTCFA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:FREIDEL
Suffix:
Gender:F
Credentials:CSTCFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 5TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6014
Mailing Address - Country:US
Mailing Address - Phone:605-343-7208
Mailing Address - Fax:605-343-7132
Practice Address - Street 1:3615 5TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6014
Practice Address - Country:US
Practice Address - Phone:605-343-7208
Practice Address - Fax:605-343-7132
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
40351246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
40351OtherNATIONAL CERTIFICATION