Provider Demographics
NPI:1952745275
Name:FRICKANISCE, MICHELLE REID (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:REID
Last Name:FRICKANISCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:RIVERSIDE MEDICAL GROUP
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:
Practice Address - Street 1:13478 CARROLLTON BLVD
Practice Address - Street 2:UNITS D & E
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-3208
Practice Address - Country:US
Practice Address - Phone:757-238-7043
Practice Address - Fax:757-238-7052
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024170786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily