Provider Demographics
NPI:1396907523
Name:FRIESEN, CHRISTINA LILLIAN (LMP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LILLIAN
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:LILLIAN
Other - Last Name:FADEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 SE 168TH AVE
Mailing Address - Street 2:#80
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-2101
Mailing Address - Country:US
Mailing Address - Phone:360-718-0651
Mailing Address - Fax:503-761-7350
Practice Address - Street 1:532 NE 3RD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2101
Practice Address - Country:US
Practice Address - Phone:360-834-6964
Practice Address - Fax:360-834-6847
Is Sole Proprietor?:No
Enumeration Date:2008-06-29
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013555174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist