Provider Demographics
NPI:1215947312
Name:FRIZZELL, MARNELL JUNE (APRN FNP)
Entity type:Individual
Prefix:MRS
First Name:MARNELL
Middle Name:JUNE
Last Name:FRIZZELL
Suffix:
Gender:F
Credentials:APRN FNP
Other - Prefix:MRS
Other - First Name:MARNELL
Other - Middle Name:JUNE
Other - Last Name:MUILENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:LAPWAI
Mailing Address - State:ID
Mailing Address - Zip Code:83540-0367
Mailing Address - Country:US
Mailing Address - Phone:208-843-2271
Mailing Address - Fax:208-843-2658
Practice Address - Street 1:313 THIRD ST
Practice Address - Street 2:
Practice Address - City:KAMIAH
Practice Address - State:ID
Practice Address - Zip Code:83536
Practice Address - Country:US
Practice Address - Phone:208-843-2271
Practice Address - Fax:208-843-2658
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN28225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8TA019Medicare ID - Type Unspecified
P76796Medicare UPIN