Provider Demographics
NPI:1346353489
Name:FREESE, JENNIFER (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:FREESE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 BUCK HILL DR
Mailing Address - Street 2:
Mailing Address - City:VEAZIE
Mailing Address - State:ME
Mailing Address - Zip Code:04401-7103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1154 BUCK HILL DR
Practice Address - Street 2:
Practice Address - City:VEAZIE
Practice Address - State:ME
Practice Address - Zip Code:04401-7103
Practice Address - Country:US
Practice Address - Phone:315-408-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine