Provider Demographics
NPI:1699822387
Name:FRISCIA, PEGGY LEE (PA)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:LEE
Last Name:FRISCIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8061 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9244
Mailing Address - Country:US
Mailing Address - Phone:734-449-8139
Mailing Address - Fax:
Practice Address - Street 1:8061 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9244
Practice Address - Country:US
Practice Address - Phone:734-449-8139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant