Provider Demographics
NPI:1740227479
Name:FREIBURGHAUS, MARY K (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:FREIBURGHAUS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:MISPLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:ONE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-3818
Practice Address - Fax:573-884-4609
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100579363L00000X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO159754OtherBLUE SHIELD/BLUE CHOICE
MO425869401Medicaid
MO484190OtherHEALTHLINK
MO008011882Medicare PIN
P61835Medicare UPIN
MO484190OtherHEALTHLINK
MO834095236Medicare PIN
MOP00308599Medicare PIN