Provider Demographics
NPI:1558502724
Name:FREEMAN, JACOB R (LPN-IV)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:R
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:LPN-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4607
Mailing Address - Country:US
Mailing Address - Phone:740-503-1934
Mailing Address - Fax:
Practice Address - Street 1:1016 2ND ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4607
Practice Address - Country:US
Practice Address - Phone:740-503-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 129393164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse