Provider Demographics
NPI:1144046301
Name:FRIBERG, ZACHARY (NP)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:FRIBERG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 E FRANKLIN RD STE 140
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2914
Mailing Address - Country:US
Mailing Address - Phone:208-992-2672
Mailing Address - Fax:
Practice Address - Street 1:660 E FRANKLIN RD STE 140
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2914
Practice Address - Country:US
Practice Address - Phone:208-992-2672
Practice Address - Fax:877-569-2323
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10036869363L00000X
ID1071540363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty