Provider Demographics
NPI:1720416621
Name:FRIESEN, STACI (RN)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:FRIESEN
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 1:6251 W TREE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-6912
Mailing Address - Country:US
Mailing Address - Phone:907-854-8173
Mailing Address - Fax:
Practice Address - Street 1:6251 W TREE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-6912
Practice Address - Country:US
Practice Address - Phone:907-854-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNUR R 32957163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse