Provider Demographics
NPI:1508648981
Name:FREEMAN, TRAVORIA
Entity Type:Individual
Prefix:
First Name:TRAVORIA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 KINGS FORK RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-7339
Mailing Address - Country:US
Mailing Address - Phone:757-469-9735
Mailing Address - Fax:
Practice Address - Street 1:3312 KINGS FORK RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-7339
Practice Address - Country:US
Practice Address - Phone:757-469-9735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide