Provider Demographics
NPI:1720361090
Name:FRIEDRICK, GAIL LYNN (PA)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:LYNN
Last Name:FRIEDRICK
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1221 SIXTH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2360
Mailing Address - Country:US
Mailing Address - Phone:231-935-2045
Mailing Address - Fax:231-935-3420
Practice Address - Street 1:1221 SIXTH ST STE 208
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2360
Practice Address - Country:US
Practice Address - Phone:231-935-2045
Practice Address - Fax:231-935-3420
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2023-06-05
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601006172OtherSTATE LICENSE