Provider Demographics
NPI:1477265262
Name:FRICKE, SHELBY
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:FRICKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WEST FREE SOIL ROAD
Mailing Address - Street 2:
Mailing Address - City:FREE SOIL
Mailing Address - State:MI
Mailing Address - Zip Code:49411
Mailing Address - Country:US
Mailing Address - Phone:616-550-3735
Mailing Address - Fax:
Practice Address - Street 1:45 WEST FREE SOIL ROAD
Practice Address - Street 2:
Practice Address - City:FREE SOIL
Practice Address - State:MI
Practice Address - Zip Code:49411
Practice Address - Country:US
Practice Address - Phone:616-550-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula