Provider Demographics
NPI:1255941555
Name:SEQUOIA HEALTH SERVICES BETTENDORF, LLC
Entity type:Organization
Organization Name:SEQUOIA HEALTH SERVICES BETTENDORF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATE
Authorized Official - Last Name:FRIESS
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:920-579-1027
Mailing Address - Street 1:1746 PAUL DR
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-3014
Mailing Address - Country:US
Mailing Address - Phone:920-850-0989
Mailing Address - Fax:
Practice Address - Street 1:770 TANGLEFOOT LN
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1608
Practice Address - Country:US
Practice Address - Phone:563-396-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUOIA INTEGRATIVE MEDICAL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty