Provider Demographics
NPI:1942868674
Name:FRIENDLY, JOHN J
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:FRIENDLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:02 COUNCIL STREET
Mailing Address - Street 2:
Mailing Address - City:EEK
Mailing Address - State:AK
Mailing Address - Zip Code:99578
Mailing Address - Country:US
Mailing Address - Phone:907-536-5314
Mailing Address - Fax:907-536-5732
Practice Address - Street 1:02 COUNCIL STREET
Practice Address - Street 2:
Practice Address - City:EEK
Practice Address - State:AK
Practice Address - Zip Code:99578
Practice Address - Country:US
Practice Address - Phone:907-536-5314
Practice Address - Fax:907-536-5732
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker