Provider Demographics
NPI:1194255307
Name:FREIBURGER, NOAH EDWARD (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:EDWARD
Last Name:FREIBURGER
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 S SHENANDOAH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1909
Mailing Address - Country:US
Mailing Address - Phone:517-614-9181
Mailing Address - Fax:
Practice Address - Street 1:426 AUDITORIUM RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-2600
Practice Address - Country:US
Practice Address - Phone:517-614-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704374326163W00000X, 163W00000X
COAPN.1000480-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health