Provider Demographics
NPI:1598110900
Name:FRIERSON, EBONISHIA
Entity Type:Individual
Prefix:
First Name:EBONISHIA
Middle Name:
Last Name:FRIERSON
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 1:5105 PHEASANT RUN DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6345
Mailing Address - Country:US
Mailing Address - Phone:989-482-6258
Mailing Address - Fax:
Practice Address - Street 1:5105 PHEASANT RUN DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6345
Practice Address - Country:US
Practice Address - Phone:989-482-6258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703115997164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse