Healthcare Provider Details

I. General information

NPI: 1205650504
Provider Name (Legal Business Name): ASHLEY NICOLE FREEBORN AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 ROSALINE AVE
REDDING CA
96001-2549
US

IV. Provider business mailing address

2905 PIONEER DR
REDDING CA
96001-0204
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-7000
  • Fax:
Mailing address:
  • Phone: 530-392-2944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95032995
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95098963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: