Provider Demographics
NPI:1982868956
Name:FREEBORN, DONNA SUSAN (FNP, CNM)
Entity Type:Individual
Prefix:PROF
First Name:DONNA
Middle Name:SUSAN
Last Name:FREEBORN
Suffix:
Gender:F
Credentials:FNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-0453
Mailing Address - Country:US
Mailing Address - Phone:801-489-1164
Mailing Address - Fax:
Practice Address - Street 1:425 N 1800 W
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-3138
Practice Address - Country:US
Practice Address - Phone:801-489-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT367022-4405363LF0000X
UT367022-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife