MEDICARE: CRYSTAL FREEMAN LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	176755	OH

General Provider Information

NPI Number	:	1003672999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL FREEMAN LPN

Provider Business Mailing Address
First Line	:	3372 SUTTON RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-4211
Country	:	US
Telephone Number	:	216-288-3718
Fax Number	:

Provider Business Practice Location Address
First Line	:	3372 SUTTON RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-4211
Country	:	US
Telephone Number	:	216-288-3718
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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