Provider Demographics
NPI:1043073711
Name:FREITAS, RYANN MICHELLE
Entity Type:Individual
Prefix:
First Name:RYANN
Middle Name:MICHELLE
Last Name:FREITAS
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 1:1317 NW 7TH CT
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-2295
Mailing Address - Country:US
Mailing Address - Phone:209-489-1144
Mailing Address - Fax:
Practice Address - Street 1:1317 NW 7TH CT
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-2295
Practice Address - Country:US
Practice Address - Phone:209-489-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA138159163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care