Provider Demographics
NPI:1790895720
Name:FREER, ELLOWEESE DENISE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ELLOWEESE
Middle Name:DENISE
Last Name:FREER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3408
Mailing Address - Country:US
Mailing Address - Phone:810-535-5555
Mailing Address - Fax:
Practice Address - Street 1:1325 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3408
Practice Address - Country:US
Practice Address - Phone:810-535-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704138274367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11909884OtherCAQH
MI1790895720Medicaid
MI4308761060OtherBCBS
MI4308761060OtherBCBS