Healthcare Provider Details

I. General information

NPI: 1891459772
Provider Name (Legal Business Name): MARY ROSS FREEMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6944 TYLERSVILLE RD
WEST CHESTER OH
45069-1511
US

IV. Provider business mailing address

6944 TYLERSVILLE RD
WEST CHESTER OH
45069-1511
US

V. Phone/Fax

Practice location:
  • Phone: 513-991-7007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209024177
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0033377
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20902177
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: