Provider Demographics
NPI:1699543199
Name:FREELAND, CARLA JEAN (LPN)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:JEAN
Last Name:FREELAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4342 BOOTES RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NY
Mailing Address - Zip Code:14507-9789
Mailing Address - Country:US
Mailing Address - Phone:607-346-2691
Mailing Address - Fax:
Practice Address - Street 1:4342 BOOTES RD
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NY
Practice Address - Zip Code:14507-9789
Practice Address - Country:US
Practice Address - Phone:607-346-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303648164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse