Provider Demographics
NPI:1104870062
Name:FREED, ELLEN D (CRNP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:D
Last Name:FREED
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RODNEY CIR
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3727
Mailing Address - Country:US
Mailing Address - Phone:610-519-0856
Mailing Address - Fax:
Practice Address - Street 1:WEST CHESTER UNIVERSITY
Practice Address - Street 2:STUDENT HEALTH AND WELLNESS CENTER
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19383-0001
Practice Address - Country:US
Practice Address - Phone:610-436-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP003009B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily