Healthcare Provider Details

I. General information

NPI: 1679998785
Provider Name (Legal Business Name): LACEY B FREEMAN A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S HEALTH PKWY
THREE RIVERS MI
49093-8352
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 269-278-1145
  • Fax: 269-273-9611
Mailing address:
  • Phone: 574-647-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number301917
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004027
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704380313
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: