Provider Demographics
NPI:1518561950
Name:FREESTONE, NANCY (NP-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:FREESTONE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E 2700 S APT K88
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2636
Mailing Address - Country:US
Mailing Address - Phone:801-440-6764
Mailing Address - Fax:
Practice Address - Street 1:3556 W 9800 S STE 10
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3211
Practice Address - Country:US
Practice Address - Phone:801-567-9780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6176768-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily