Provider Demographics
NPI:1134425457
Name:FREEMAN, DONA RAE GRACE (LMP)
Entity type:Individual
Prefix:
First Name:DONA RAE
Middle Name:GRACE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-3604
Mailing Address - Country:US
Mailing Address - Phone:253-306-9835
Mailing Address - Fax:
Practice Address - Street 1:3701 6TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-4950
Practice Address - Country:US
Practice Address - Phone:253-306-9835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60204116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist