Organization
SEQUOIA INTEGRATIVE MEDICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY K FRIESS APNP (PRESIDENT)
(920) 422-7402
Entity
Organization
Contact information
Practice address
1746 PAUL DR, KAUKAUNA, WI 54130-3014
(920) 422-7402
Mailing address
PO BOX 411, RIVERSIDE, IL 60546-6411
(920) 422-7402
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
225X00000X
Occupational Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36015700
—
WI
Enumeration date
03/25/2020
Last updated
04/17/2026
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