Provider Demographics
NPI:1679748644
Name:FRIEDRICH, MELISSA DAWN (CRNA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:FRIEDRICH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DAWN
Other - Last Name:EIGHMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5901 WESTOWN PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8297
Mailing Address - Country:US
Mailing Address - Phone:515-221-9222
Mailing Address - Fax:515-221-0575
Practice Address - Street 1:5901 WESTOWN PKWY STE 210
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8297
Practice Address - Country:US
Practice Address - Phone:515-221-9222
Practice Address - Fax:515-221-0575
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD-108512367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA50171OtherGROUP