Provider Demographics
NPI:1457685083
Name:FRIESEN, MELISSA J (MS, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:MS, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 OLD TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1054
Mailing Address - Country:US
Mailing Address - Phone:937-236-0290
Mailing Address - Fax:937-237-0519
Practice Address - Street 1:8501 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1054
Practice Address - Country:US
Practice Address - Phone:937-236-0290
Practice Address - Fax:937-237-0519
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11033-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily