Provider Demographics
NPI:1730680265
Name:FREEMAN, NICOLE RUSH (RN)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:RUSH
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ROBIN
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:503 N EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:MART
Mailing Address - State:TX
Mailing Address - Zip Code:76664-1242
Mailing Address - Country:US
Mailing Address - Phone:254-717-8771
Mailing Address - Fax:
Practice Address - Street 1:503 N EMERSON ST
Practice Address - Street 2:
Practice Address - City:MART
Practice Address - State:TX
Practice Address - Zip Code:76664-1242
Practice Address - Country:US
Practice Address - Phone:254-717-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX584324163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse