Provider Demographics
NPI:1649250119
Name:FRIESNER, STACY ANN (CNP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:FRIESNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S MAIN ST STE CEANDF
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8096
Mailing Address - Country:US
Mailing Address - Phone:704-997-5525
Mailing Address - Fax:
Practice Address - Street 1:2001 VAN HAVEN DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-4342
Practice Address - Country:US
Practice Address - Phone:704-883-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014466363LA2100X
OHCOA06893.NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP10235Medicare PIN