Healthcare Provider Details

I. General information

NPI: 1255707592
Provider Name (Legal Business Name): AMY CRYSTAL FREEMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 GLASS RD NE
CEDAR RAPIDS IA
52402-2514
US

IV. Provider business mailing address

4205 GLASS RD NE
CEDAR RAPIDS IA
52402-2514
US

V. Phone/Fax

Practice location:
  • Phone: 319-294-0094
  • Fax:
Mailing address:
  • Phone: 319-294-0094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA129170
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: