Provider Demographics
NPI:1265545032
Name:FREESTONE, PATRICE A (HIS)
Entity type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:A
Last Name:FREESTONE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 LEGACY PLZ W
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-5296
Mailing Address - Country:US
Mailing Address - Phone:219-324-6608
Mailing Address - Fax:219-324-6058
Practice Address - Street 1:406 LEGACY PLZ W
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5296
Practice Address - Country:US
Practice Address - Phone:219-324-6608
Practice Address - Fax:219-324-6058
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001089A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist