Provider Demographics
NPI:1336858836
Name:FRIEDE, JACQUELINE RAE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RAE
Last Name:FRIEDE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 12TH AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5017
Mailing Address - Country:US
Mailing Address - Phone:406-761-5252
Mailing Address - Fax:
Practice Address - Street 1:2300 12TH AVE S STE 101
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5017
Practice Address - Country:US
Practice Address - Phone:406-761-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT203969363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily