Provider Demographics
NPI:1235228917
Name:FREEMAN, PRESWINDA CORNEJO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:PRESWINDA
Middle Name:CORNEJO
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 W PURDUE AVE
Mailing Address - Street 2:VA PRIMARY CARE CLINIC
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-6357
Mailing Address - Country:US
Mailing Address - Phone:765-284-7386
Mailing Address - Fax:
Practice Address - Street 1:3500 W PURDUE AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-6357
Practice Address - Country:US
Practice Address - Phone:765-284-6822
Practice Address - Fax:765-284-6855
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000864A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health