Healthcare Provider Details

I. General information

NPI: 1043838527
Provider Name (Legal Business Name): LATASHA LYNNE FREEMAN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD BLDG 5TH
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

3200 E CAMELBACK RD STE 250
PHOENIX AZ
85018-2327
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0393
  • Fax: 602-933-5525
Mailing address:
  • Phone: 602-933-1814
  • Fax: 602-933-8972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number242758
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: