Provider Demographics
NPI:1053639013
Name:FREEZE, MINDE R
Entity Type:Individual
Prefix:
First Name:MINDE
Middle Name:R
Last Name:FREEZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MINDE
Other - Middle Name:R
Other - Last Name:HELMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3362 E COUNTY ROAD 113
Mailing Address - Street 2:
Mailing Address - City:GREEN SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:44836-9002
Mailing Address - Country:US
Mailing Address - Phone:419-603-6938
Mailing Address - Fax:419-639-9910
Practice Address - Street 1:3362 E COUNTY ROAD 113
Practice Address - Street 2:
Practice Address - City:GREEN SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:44836-9002
Practice Address - Country:US
Practice Address - Phone:419-603-6938
Practice Address - Fax:419-639-9910
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400510890605376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide