Provider Demographics
NPI:1467437830
Name:FREIS, CATHY J (NP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:J
Last Name:FREIS
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 1:2714 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-6715
Mailing Address - Country:US
Mailing Address - Phone:920-430-4760
Mailing Address - Fax:
Practice Address - Street 1:2714 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-6715
Practice Address - Country:US
Practice Address - Phone:920-430-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI894363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI894-033OtherLICENSE
WI075100019Medicare Oscar/Certification
WIK400128720Medicare Oscar/Certification
WI894-033OtherLICENSE
WI001707305Medicare Oscar/Certification
500004366Medicare Oscar/Certification
WI000017Medicare Oscar/Certification