Provider Demographics
NPI:1518182914
Name:FREEMAN, ROSEANNA (OPA C ST)
Entity Type:Individual
Prefix:MRS
First Name:ROSEANNA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:OPA C ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:C 135
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2571
Mailing Address - Country:US
Mailing Address - Phone:972-566-5564
Mailing Address - Fax:972-566-7556
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C-135
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-5564
Practice Address - Fax:972-566-7556
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
056191 - SUR TECH #246ZS0410X
TX056191-CERTSURGTECH246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX648OtherOPA CERTIFICATION