Healthcare Provider Details

I. General information

NPI: 1841353208
Provider Name (Legal Business Name): SUE FREEMAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19303 N NEW TRADITION RD
SUN CITY WEST AZ
85375-3806
US

IV. Provider business mailing address

1144 65TH ST STE F
OAKLAND CA
94608-1053
US

V. Phone/Fax

Practice location:
  • Phone: 623-624-8280
  • Fax: 602-835-0192
Mailing address:
  • Phone: 510-929-1400
  • Fax: 510-929-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN-092188
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP6923
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: