Healthcare Provider Details

I. General information

NPI: 1932269487
Provider Name (Legal Business Name): DIANE K FREEDMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BOSTON ST NORTH SHORE MEDICAL CENTER
LYNN MA
01904
US

IV. Provider business mailing address

11 SUNSET DRIVE
PEABODY MA
01960
US

V. Phone/Fax

Practice location:
  • Phone: 781-599-3109
  • Fax: 781-599-3162
Mailing address:
  • Phone: 978-532-4384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number130352
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: