Provider Demographics
NPI:1699931493
Name:FRIZELLE, MICHAEL K (FNP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:FRIZELLE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8875 ELLSWORTH CT NE
Mailing Address - Street 2:503
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3883
Mailing Address - Country:US
Mailing Address - Phone:503-440-3578
Mailing Address - Fax:
Practice Address - Street 1:77 WAINWRIGHT DR VA MEDICAL CENTER
Practice Address - Street 2:JONATHAN M WAINWRIGHT MEMORIAL
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-9814
Practice Address - Country:US
Practice Address - Phone:503-440-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2962202363LF0000X
WA60101140363LF0000X
TX737610363LF0000X
OR200843205RN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60101140OtherVETERAN ADMIN
TX737610OtherPRIVATE PRACTICE ONLY
FL2962202OtherMILITARY PRACTICE ONLY
OR200843205RNOtherVETERAN ADMIN