Basic Information
| Provider Information | |||||||||
| NPI: | 1952745275 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRICKANISCE | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | REID | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 856 J CLYDE MORRIS BLVD STE A | ||||||||
| Address2: | RIVERSIDE MEDICAL GROUP | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236011318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575944006 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13478 CARROLLTON BLVD | ||||||||
| Address2: | UNITS D & E | ||||||||
| City: | CARROLLTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233143208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572387043 | ||||||||
| FaxNumber: | 7572387052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2013 | ||||||||
| LastUpdateDate: | 01/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024170786 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.