Provider Demographics
NPI:1134231558
Name:FREUND, MARY (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FREUND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 US HIGHWAY 20 S
Mailing Address - Street 2:
Mailing Address - City:BASIN
Mailing Address - State:WY
Mailing Address - Zip Code:82410-8902
Mailing Address - Country:US
Mailing Address - Phone:307-568-3311
Mailing Address - Fax:307-568-2139
Practice Address - Street 1:388 US HIGHWAY 20 S
Practice Address - Street 2:
Practice Address - City:BASIN
Practice Address - State:WY
Practice Address - Zip Code:82410-8902
Practice Address - Country:US
Practice Address - Phone:307-568-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14285.0135363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY108493300Medicaid
WY108493300Medicaid
080111245Medicare ID - Type UnspecifiedRAILROAD MEDICARE PROVIDE
R04488Medicare UPIN