Provider Demographics
NPI:1942422068
Name:FRISTAD, BEVERLY A (RN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:FRISTAD
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 1:599 GARLAND CT N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5640
Mailing Address - Country:US
Mailing Address - Phone:503-779-5504
Mailing Address - Fax:
Practice Address - Street 1:412 NE FORD ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4608
Practice Address - Country:US
Practice Address - Phone:503-434-7525
Practice Address - Fax:503-434-7549
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR076035964RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health