Healthcare Provider Details

I. General information

NPI: 1851132708
Provider Name (Legal Business Name): PAYTON FREEMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAITH REGIONAL HEALTH SERVICES 2700 W NORFOLK AVE
NORFOLK NE
68701
US

IV. Provider business mailing address

55780 851ST RD
PIERCE NE
68767-5714
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-4880
  • Fax:
Mailing address:
  • Phone: 402-750-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101857
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: