Provider Demographics
NPI:1114216173
Name:FRIER, KENYETTA (RN)
Entity Type:Individual
Prefix:
First Name:KENYETTA
Middle Name:
Last Name:FRIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KENYETTA
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7942 N 107TH ST
Mailing Address - Street 2:APT 4
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-3170
Mailing Address - Country:US
Mailing Address - Phone:414-393-8779
Mailing Address - Fax:
Practice Address - Street 1:7942 N 107TH ST
Practice Address - Street 2:APT 4
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3170
Practice Address - Country:US
Practice Address - Phone:414-393-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI186217-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse