Provider Demographics
NPI:1366310039
Name:FREMAN, JASON SEAN
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:SEAN
Last Name:FREMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4865 BRIDLE TRL
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4206
Mailing Address - Country:US
Mailing Address - Phone:707-328-1033
Mailing Address - Fax:707-328-1033
Practice Address - Street 1:4865 BRIDLE TRL
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4206
Practice Address - Country:US
Practice Address - Phone:707-328-1033
Practice Address - Fax:707-328-1033
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-25
Last Update Date:2025-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA680564163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty