Provider Demographics
NPI:1184836660
Name:FRIEDRICH, ALICE DAWN (ANP)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:DAWN
Last Name:FRIEDRICH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:57 KETCHAM AVENUE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701
Mailing Address - Country:US
Mailing Address - Phone:631-691-5456
Mailing Address - Fax:
Practice Address - Street 1:43 CROSSWAYS PARK DRIVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797
Practice Address - Country:US
Practice Address - Phone:516-938-3000
Practice Address - Fax:516-992-5219
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301906-1163WC0200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine