Provider Demographics
NPI:1467222828
Name:FREEMAN, PENNY A
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:A
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:A
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:45975 HIGHWAY 50 W
Mailing Address - Street 2:
Mailing Address - City:DONNYBROOK
Mailing Address - State:ND
Mailing Address - Zip Code:58734-2915
Mailing Address - Country:US
Mailing Address - Phone:208-290-3694
Mailing Address - Fax:
Practice Address - Street 1:45975 HIGHWAY 50 W
Practice Address - Street 2:
Practice Address - City:DONNYBROOK
Practice Address - State:ND
Practice Address - Zip Code:58734-2915
Practice Address - Country:US
Practice Address - Phone:208-290-3694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health