Provider Demographics
NPI:1821487968
Name:FREEMAN, MARY AGNES (RN)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:AGNES
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3005 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3228
Mailing Address - Country:US
Mailing Address - Phone:913-262-0358
Mailing Address - Fax:
Practice Address - Street 1:3005 W 74TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3228
Practice Address - Country:US
Practice Address - Phone:913-262-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1358875072163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse