Provider Demographics
NPI:1679599831
Name:FRIEDLY, KATHARINA MARIA (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHARINA
Middle Name:MARIA
Last Name:FRIEDLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 PINEGROVE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3347
Mailing Address - Country:US
Mailing Address - Phone:937-434-8807
Mailing Address - Fax:
Practice Address - Street 1:2630 PINEGROVE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3347
Practice Address - Country:US
Practice Address - Phone:937-434-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 215290163WC1600X, 163WH0200X, 163WN1003X, 163WP0200X, 163WP0808X, 163WX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Not Answered163WX1100XNursing Service ProvidersRegistered NurseOphthalmic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH226-3723Medicaid