Provider Demographics
NPI:1740457357
Name:FRIZZELL, JOAN PARKER (CRNP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:PARKER
Last Name:FRIZZELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1737
Mailing Address - Country:US
Mailing Address - Phone:215-509-6826
Mailing Address - Fax:215-487-4274
Practice Address - Street 1:5800 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1737
Practice Address - Country:US
Practice Address - Phone:215-509-6826
Practice Address - Fax:215-487-4274
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN225449L163W00000X
PASP009212363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA328912YMEMMedicare PIN