Provider Demographics
NPI:1093395469
Name:FREEMAN, CORRINE (PMHNP-STUDENT)
Entity Type:Individual
Prefix:MRS
First Name:CORRINE
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PMHNP-STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 N 1200 E STE 104
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2255
Mailing Address - Country:US
Mailing Address - Phone:801-377-0088
Mailing Address - Fax:
Practice Address - Street 1:179 N 1200 E STE 104
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2255
Practice Address - Country:US
Practice Address - Phone:801-377-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6263133-3102163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health