Provider Demographics
NPI:1083002984
Name:FRIESEN, COURTNEY (APRN-BC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:BEIRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:PO BOX 47490
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7490
Mailing Address - Country:US
Mailing Address - Phone:316-962-3150
Mailing Address - Fax:316-962-7334
Practice Address - Street 1:550 N HILLSIDE ST
Practice Address - Street 2:BUILDING 1, 6TH FLOOR
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4910
Practice Address - Country:US
Practice Address - Phone:316-962-7422
Practice Address - Fax:316-962-7805
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76635363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics