Provider Demographics
NPI:1740254739
Name:FRIED, DENISE EILEEN (PA-C)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:EILEEN
Last Name:FRIED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4423
Mailing Address - Country:US
Mailing Address - Phone:701-323-6815
Mailing Address - Fax:701-323-6516
Practice Address - Street 1:414 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4423
Practice Address - Country:US
Practice Address - Phone:701-323-6815
Practice Address - Fax:701-323-6516
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0106363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10116Medicaid
ND24787Medicare ID - Type Unspecified
ND10116Medicaid