Provider Demographics
NPI:1801277488
Name:FRIED, GERALDINE (CRNP)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:FRIED
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:BROWN
Other - Last Name:FRIED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:4 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1605
Mailing Address - Country:US
Mailing Address - Phone:610-994-1136
Mailing Address - Fax:
Practice Address - Street 1:4 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1605
Practice Address - Country:US
Practice Address - Phone:610-994-1136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP000957C363LA2200X
PASP011576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health