Individual
KAITLYN FRIESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
PO BOX 1017, HAYDEN, ID 83835-1017
(123) 123-1234
Mailing address
PO BOX 1017, HAYDEN, ID 83835-1017
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
66663
CA
Other
Enumeration date
09/20/2025
Last updated
09/20/2025
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