Provider Demographics
NPI:1316166150
Name:FRISCO, LEANORA A (CRNA)
Entity type:Individual
Prefix:MS
First Name:LEANORA
Middle Name:A
Last Name:FRISCO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 KADEL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-1223
Mailing Address - Country:US
Mailing Address - Phone:973-398-8390
Mailing Address - Fax:973-972-2357
Practice Address - Street 1:19 KADEL DR
Practice Address - Street 2:
Practice Address - City:MOUNT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-1223
Practice Address - Country:US
Practice Address - Phone:973-398-8390
Practice Address - Fax:973-972-2357
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO06699100367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ079938Medicare ID - Type Unspecified