Provider Demographics
NPI:1043519432
Name:FREELY, EDWARD L JR (RN)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:L
Last Name:FREELY
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 TILLOTSON PL
Mailing Address - Street 2:TONAWANDA
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2828
Mailing Address - Country:US
Mailing Address - Phone:585-413-6288
Mailing Address - Fax:
Practice Address - Street 1:37 TILLOTSON PL
Practice Address - Street 2:TONAWANDA
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-2828
Practice Address - Country:US
Practice Address - Phone:585-413-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY543151-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult