Provider Demographics
NPI:1194784595
Name:FREELAND, BONNIE LEE (NP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LEE
Last Name:FREELAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MCCANNEL HALL ROOM 100
Mailing Address - Street 2:2891 2ND AVENUE NORTH STOP 9038
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-9038
Mailing Address - Country:US
Mailing Address - Phone:701-777-4500
Mailing Address - Fax:
Practice Address - Street 1:MCCANNEL HALL ROOM 100
Practice Address - Street 2:2891 2ND AVENUE NORTH STOP 9038
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-9038
Practice Address - Country:US
Practice Address - Phone:701-777-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR24760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19581Medicaid
ND19581Medicaid
NDS24582Medicare UPIN