Provider Demographics
NPI:1891389706
Name:FRIEDE, MAGGIE ROSE (APNP)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ROSE
Last Name:FRIEDE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-6125
Mailing Address - Country:US
Mailing Address - Phone:630-240-5021
Mailing Address - Fax:
Practice Address - Street 1:N20W22961 WATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1306
Practice Address - Country:US
Practice Address - Phone:262-875-5070
Practice Address - Fax:866-384-9486
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14461-33363LP0808X
WI249223163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse