Provider Demographics
NPI:1629538939
Name:FREEMAN, MONICA DIANE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:DIANE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:DIANE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2685 ADEN AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0262
Mailing Address - Country:US
Mailing Address - Phone:704-300-6013
Mailing Address - Fax:
Practice Address - Street 1:170 AMENDMENT AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3073
Practice Address - Country:US
Practice Address - Phone:803-324-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22655363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner