Provider Demographics
NPI:1104510692
Name:FREEMAN, MONICA TENNELLE
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:TENNELLE
Last Name:FREEMAN
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 1:230 HIGHLAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-3601
Mailing Address - Country:US
Mailing Address - Phone:330-615-9945
Mailing Address - Fax:
Practice Address - Street 1:230 HIGHLAND AVE SW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-3601
Practice Address - Country:US
Practice Address - Phone:330-615-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker