Provider Demographics
NPI:1790926210
Name:FREELAND, AUTUMN M (PA)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:M
Last Name:FREELAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-5220
Mailing Address - Fax:208-367-5223
Practice Address - Street 1:3250 W CHERRY LANE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1026
Practice Address - Country:US
Practice Address - Phone:208-367-5220
Practice Address - Fax:208-367-5223
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-793363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant