Provider Demographics
NPI:1780890954
Name:FRIEND, JOHN C (MSN, FNP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:FRIEND
Suffix:
Gender:M
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 INA CT
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2144
Mailing Address - Country:US
Mailing Address - Phone:415-282-2450
Mailing Address - Fax:415-502-9566
Practice Address - Street 1:995 POTRERO AVE
Practice Address - Street 2:WARD 86
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2859
Practice Address - Country:US
Practice Address - Phone:415-206-2400
Practice Address - Fax:415-502-9566
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMF0502410OtherDEA
CAP97873Medicare UPIN