Healthcare Provider Details

I. General information

NPI: 1396753257
Provider Name (Legal Business Name): JAMIE JANELLE FREEMAN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 SW SIMPSON AVE SUITE 300
BEND OR
97702-3599
US

IV. Provider business mailing address

929 SW SIMPSON AVE SUITE 300
BEND OR
97702-3599
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-7741
  • Fax: 541-278-8376
Mailing address:
  • Phone: 541-389-7741
  • Fax: 541-278-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00944
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: