Provider Demographics
NPI:1851310742
Name:FREEMAN, LEE W (CRNA)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:W
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5154
Mailing Address - Country:US
Mailing Address - Phone:970-350-6399
Mailing Address - Fax:970-378-4687
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5154
Practice Address - Country:US
Practice Address - Phone:970-350-6399
Practice Address - Fax:970-378-4687
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC192489163W00000X, 163WM0705X, 367500000X
COSRA-25014367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42070546Medicaid
NC192489OtherRN LICENSE
NC8052573Medicaid
NC8052573Medicaid
NC2610906Medicare PIN
COCO307617Medicare PIN