Basic Information
| Provider Information | |||||||||
| NPI: | 1871520114 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRISK | ||||||||
| FirstName: | CARI | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | AUD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOVCHAN | ||||||||
| OtherFirstName: | CARI | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 UNIVERSITY DR S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581034940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/17/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 776 | ND | Y | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 7360 | MN | N | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 059H3MO | 01 | ND | MNBS # | OTHER | 21151 | 01 | MN | NDBS # | OTHER | 49G45MO | 01 | ND | MNBS # | OTHER | 640004325 | 01 | ND | RAILROAD | OTHER | ND200220 | 01 | ND | LHS # | OTHER | 1344496 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | 4500100 | 01 | ND | MEDICA # | OTHER | DA9011046495 | 01 | ND | PREFERRED ONE # | OTHER | 103180 | 01 | ND | UCARE # | OTHER | 20611 | 01 | ND | NDBS # | OTHER | 26549 | 01 | ND | NDBS # | OTHER | 4500548 | 01 | ND | MEDICA # | OTHER | 49G14MO | 01 | MN | MNBS # | OTHER | 51953 | 05 | ND | MEDICAID | 640000121 | 01 | MN | MN MEDICARE # | OTHER | HP32805 | 01 | ND | HEALTHPARTNERS # | OTHER |