Provider Demographics
NPI:1891026142
Name:FREELAND, MARY LORENE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LORENE
Last Name:FREELAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7729
Mailing Address - Country:US
Mailing Address - Phone:623-915-8403
Mailing Address - Fax:623-915-8437
Practice Address - Street 1:2217 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7729
Practice Address - Country:US
Practice Address - Phone:623-915-8403
Practice Address - Fax:623-915-8437
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN111512163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse