Provider Demographics
NPI:1003862145
Name:FREEMAN, BRENDA JOYCE (CNM)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JOYCE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13152 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3469
Mailing Address - Country:US
Mailing Address - Phone:714-442-4864
Mailing Address - Fax:714-442-4892
Practice Address - Street 1:13152 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3469
Practice Address - Country:US
Practice Address - Phone:714-442-4864
Practice Address - Fax:714-442-4892
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66963367A00000X
CA1283367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBJCNM1983Medicaid
ILBJCNM1983Medicare ID - Type UnspecifiedMIDWIFE
ILBJCNM1983Medicaid