Provider Demographics
NPI:1366461154
Name:FRIESEN, ELIZABETH E (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 LINCOLN GAP RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:VT
Mailing Address - Zip Code:05443-9818
Mailing Address - Country:US
Mailing Address - Phone:802-453-3587
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-8200
Practice Address - Fax:802-847-8742
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010025689363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010810Medicaid
NP4688Medicare ID - Type Unspecified
Q22394Medicare UPIN