Provider Demographics
NPI:1851698948
Name:FRIESEN, MILADYS A (FNP)
Entity Type:Individual
Prefix:
First Name:MILADYS
Middle Name:A
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W. LAS COLINAS BLVD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:469-733-1894
Practice Address - Street 1:410 E. PIONEER PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75071
Practice Address - Country:US
Practice Address - Phone:469-733-1890
Practice Address - Fax:469-733-1894
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX532229363LF0000X
TXAP114166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349592YXETMedicare PIN