Healthcare Provider Details

I. General information

NPI: 1578547725
Provider Name (Legal Business Name): MAUREEN ELHARD FREEMAN CNM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E PARADISE RD PARADISE MEDICAL OFFICE
MODESTO CA
95351
US

IV. Provider business mailing address

401 PARADISE RD
MODESTO CA
95351-3104
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4000
  • Fax: 209-558-5066
Mailing address:
  • Phone: 209-558-4000
  • Fax: 209-558-5066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16189
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number611
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP16189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: