Provider Demographics
NPI:1356338966
Name:FRIESEN, CATHERINE DIANE (ARNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DIANE
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:DIANE
Other - Last Name:FRIESEN-TABKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:611 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MENNO
Mailing Address - State:SD
Mailing Address - Zip Code:57045-2021
Mailing Address - Country:US
Mailing Address - Phone:712-540-4669
Mailing Address - Fax:
Practice Address - Street 1:611 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MENNO
Practice Address - State:SD
Practice Address - Zip Code:57045-2021
Practice Address - Country:US
Practice Address - Phone:712-540-4669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA084320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS47781Medicare UPIN