Provider Demographics
NPI:1891030177
Name:FREEMAN, CORINA JO
Entity type:Individual
Prefix:MRS
First Name:CORINA
Middle Name:JO
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 815
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17481 US ROUTE 11
Practice Address - Street 2:33-N
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5344
Practice Address - Country:US
Practice Address - Phone:315-788-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286277-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse