Provider Demographics
NPI:1417010315
Name:FREEMAN, DEANNA LATRISE (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:LATRISE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24321 TAMARACK CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6182
Mailing Address - Country:US
Mailing Address - Phone:248-595-1054
Mailing Address - Fax:
Practice Address - Street 1:4160 JOHN R ST STE 510
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2021
Practice Address - Country:US
Practice Address - Phone:313-993-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704218153163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse