Provider Demographics
NPI:1902489230
Name:FRIEDERICH, NICOLE M (RN, NNP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:FRIEDERICH
Suffix:
Gender:F
Credentials:RN, NNP
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:LILLIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7740 HOWE DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VLG
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4226
Mailing Address - Country:US
Mailing Address - Phone:816-550-5353
Mailing Address - Fax:
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017001282163W00000X
MO2021031647363L00000X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner