Basic Information
Provider Information
NPI: 1003292269
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRISQUE
FirstName: BRITTANY
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1640 E SUMNER ST
Address2:  
City: HARTFORD
State: WI
PostalCode: 530272684
CountryCode: US
TelephoneNumber: 2626704000
FaxNumber:  
Practice Location
Address1: 1640 E SUMNER ST
Address2:  
City: HARTFORD
State: WI
PostalCode: 530272684
CountryCode: US
TelephoneNumber: 2626704000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/10/2015
LastUpdateDate: 01/18/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X6534WIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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