Provider Demographics
NPI:1538657564
Name:FREEMAN, LATOYA DENISE (ACCNS-AG, APRN)
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:DENISE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:ACCNS-AG, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13570 S CUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2393
Mailing Address - Country:US
Mailing Address - Phone:614-701-6390
Mailing Address - Fax:
Practice Address - Street 1:13570 S CUMBERLAND DR
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-2393
Practice Address - Country:US
Practice Address - Phone:614-701-6390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019357364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care