Provider Demographics
NPI:1205328333
Name:FREED, KRYSTA MARIA (LM, CPM)
Entity type:Individual
Prefix:
First Name:KRYSTA
Middle Name:MARIA
Last Name:FREED
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 S WIDGEON ST
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6212
Mailing Address - Country:US
Mailing Address - Phone:208-964-1394
Mailing Address - Fax:208-567-1640
Practice Address - Street 1:6456 W KAMLOOPS DR
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-6417
Practice Address - Country:US
Practice Address - Phone:208-699-3625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife