Provider Demographics
NPI:1336434414
Name:FREEMAN, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:VANESSA
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1348 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7557
Mailing Address - Country:US
Mailing Address - Phone:530-518-3001
Mailing Address - Fax:
Practice Address - Street 1:1348 JACKSON ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7557
Practice Address - Country:US
Practice Address - Phone:530-518-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 243973164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse