Provider Demographics
NPI:1447035910
Name:FRIEDRICHS, ALBA
Entity type:Individual
Prefix:
First Name:ALBA
Middle Name:
Last Name:FRIEDRICHS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12575 W CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6333
Mailing Address - Country:US
Mailing Address - Phone:602-791-6201
Mailing Address - Fax:
Practice Address - Street 1:7402 W CATALINA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-5502
Practice Address - Country:US
Practice Address - Phone:602-764-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP036027164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse