Provider Demographics
NPI:1588641484
Name:FRISCH, REBECCA S (PAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:FRISCH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638-2046
Mailing Address - Country:US
Mailing Address - Phone:319-824-6945
Mailing Address - Fax:319-824-6947
Practice Address - Street 1:606 E 1ST ST
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-2046
Practice Address - Country:US
Practice Address - Phone:319-824-6945
Practice Address - Fax:319-824-6947
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS99629Medicare UPIN
IA14325Medicare ID - Type Unspecified