Provider Demographics
NPI:1437698370
Name:FREEMAN, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5242 COUNTY ROAD 2480
Mailing Address - Street 2:
Mailing Address - City:HIGBEE
Mailing Address - State:MO
Mailing Address - Zip Code:65257-2433
Mailing Address - Country:US
Mailing Address - Phone:573-397-1191
Mailing Address - Fax:
Practice Address - Street 1:5242 COUNTY ROAD 2480
Practice Address - Street 2:
Practice Address - City:HIGBEE
Practice Address - State:MO
Practice Address - Zip Code:65257
Practice Address - Country:US
Practice Address - Phone:573-397-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012016900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse