Provider Demographics
NPI:1730493214
Name:FREEMAN, JANIS E (FNP)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:E
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:99 EAST STATE STREET
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-0010
Mailing Address - Country:US
Mailing Address - Phone:518-775-4205
Mailing Address - Fax:518-775-4225
Practice Address - Street 1:434 S KINGSBORO AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-3822
Practice Address - Country:US
Practice Address - Phone:518-752-5275
Practice Address - Fax:518-752-5277
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336439-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03276542Medicaid
NY03276542Medicaid