Provider Demographics
NPI:1881147569
Name:FREEMAN, FANTA (CNM)
Entity type:Individual
Prefix:
First Name:FANTA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:FANTA
Other - Middle Name:
Other - Last Name:CONDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1150 RESERVOIR AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6032
Mailing Address - Country:US
Mailing Address - Phone:401-223-2828
Mailing Address - Fax:401-223-2825
Practice Address - Street 1:1150 RESERVOIR AVE STE 300
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6032
Practice Address - Country:US
Practice Address - Phone:401-223-2828
Practice Address - Fax:401-223-2825
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICNM00203367A00000X
RICNM08148207VX0000X, 207VX0000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics