Healthcare Provider Details

I. General information

NPI: 1477538403
Provider Name (Legal Business Name): SUSAN JEAN FREEBURN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 E WEST HWY SUITE 6-100
SILVER SPRING MD
20910-3225
US

IV. Provider business mailing address

3917 HALSEY ST
KENSINGTON MD
20895-1516
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-8118
  • Fax: 301-295-7217
Mailing address:
  • Phone: 301-295-8118
  • Fax: 301-295-7217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR086056
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: