Provider Demographics
NPI:1053302778
Name:FREEMAN, JOANNE ALETHA (CPNP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:ALETHA
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:ALETHA
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:784 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2315
Mailing Address - Country:US
Mailing Address - Phone:360-425-6111
Mailing Address - Fax:360-636-1297
Practice Address - Street 1:784 14TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2315
Practice Address - Country:US
Practice Address - Phone:360-425-6111
Practice Address - Fax:360-636-1297
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00120002163WP0200X
WAAP30003667363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA129607OtherWA LABOR & INDUSTRIES
WA9615436Medicaid
OR036033Medicaid
OR036033Medicaid
WA9615436Medicaid