Provider Demographics
NPI:1356657639
Name:FREEMAN, CHARLISE A (RN)
Entity Type:Individual
Prefix:MS
First Name:CHARLISE
Middle Name:A
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181362
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-7362
Mailing Address - Country:US
Mailing Address - Phone:216-650-0313
Mailing Address - Fax:
Practice Address - Street 1:4949 TURNEY RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2527
Practice Address - Country:US
Practice Address - Phone:216-650-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0031244104100000X
OH345446163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No104100000XBehavioral Health & Social Service ProvidersSocial Worker