Provider Demographics
NPI:1881310068
Name:FREEBORN, HEIDI JO (APRN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JO
Last Name:FREEBORN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JO
Other - Last Name:KIDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10335 BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8376
Mailing Address - Country:US
Mailing Address - Phone:907-727-1642
Mailing Address - Fax:
Practice Address - Street 1:425 E DAHLIA AVE STE M
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6463
Practice Address - Country:US
Practice Address - Phone:907-376-2411
Practice Address - Fax:907-352-3301
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURR36448163W00000X
AK199969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse