Provider Demographics
NPI:1336498294
Name:FREISE, MEGAN E (APRN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:FREISE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1516 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1696
Mailing Address - Country:US
Mailing Address - Phone:785-232-1005
Mailing Address - Fax:785-232-2564
Practice Address - Street 1:1516 SW 6TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1696
Practice Address - Country:US
Practice Address - Phone:785-232-1005
Practice Address - Fax:785-232-2564
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002292OtherMEDICARE