Provider Demographics
NPI:1063936417
Name:FREELAND, REBECCA SUE (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:FREELAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4191 21 MILE RD
Mailing Address - Street 2:
Mailing Address - City:KENT CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4191 21 MILE RD
Practice Address - Street 2:
Practice Address - City:KENT CITY
Practice Address - State:MI
Practice Address - Zip Code:49330-9400
Practice Address - Country:US
Practice Address - Phone:616-799-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704220579163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse