Healthcare Provider Details

I. General information

NPI: 1891461927
Provider Name (Legal Business Name): GAYLE L FREEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 W PRAIRIE SHOPPING CTR
HAYDEN ID
83835-9854
US

IV. Provider business mailing address

25 E MARYANNA LN
HAYDEN ID
83835-5162
US

V. Phone/Fax

Practice location:
  • Phone: 208-772-2774
  • Fax:
Mailing address:
  • Phone: 208-277-7354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN-35243
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: