Provider Demographics
NPI:1639252422
Name:FREEMAN, DEBORAH JEAN (NP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JEAN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1001 W FAYETTE STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-476-1792
Practice Address - Street 1:4820 WEST TAFT ROAD
Practice Address - Street 2:STE 108
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:315-413-0004
Practice Address - Fax:315-413-0828
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY334674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02850080Medicaid
NYP00457379Medicare PIN
NYRB3140Medicare PIN