MEDICARE: MS. CHARLISE A FREEMAN RN

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	104100000X	Social Worker	0031244	OH
2	163W00000X	Registered Nurse	345446	OH

General Provider Information

NPI Number	:	1356657639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARLISE A FREEMAN RN

Provider Business Mailing Address
First Line	:	PO BOX 181362
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-7362
Country	:	US
Telephone Number	:	216-650-0313
Fax Number	:

Provider Business Practice Location Address
First Line	:	4949 TURNEY RD
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2527
Country	:	US
Telephone Number	:	216-650-0313
Fax Number	:

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

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	02/09/2016

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