Provider Demographics
NPI:1013952571
Name:FREELAND, LISA H (CNM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:FREELAND
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N IRON BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4932
Mailing Address - Country:US
Mailing Address - Phone:509-444-8888
Mailing Address - Fax:509-444-7806
Practice Address - Street 1:3919 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1349
Practice Address - Country:US
Practice Address - Phone:509-444-8200
Practice Address - Fax:509-444-7806
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60210577163WX0002X
WA6836367A00000X
WAAP60210579363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8908948OtherMEDICARE PTAN
WAAP60210579OtherADVANCED REGISTERED NURSE PRACTIONER
WA6836OtherCNM
WA1013952571Medicaid
WARN60210577OtherREGISTERED NURSE
WARN60210577OtherREGISTERED NURSE
WAG8908948OtherMEDICARE PTAN