Healthcare Provider Details

I. General information

NPI: 1114206042
Provider Name (Legal Business Name): CONNIE BEIRO FREEMAN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CONNIE BEIRO

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MOUNTAIN BLVD
WILKES BARRE PA
18711-0027
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-7300
  • Fax:
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number101-0134470
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number2671445
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPN.1000830-NP
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberCNP01795
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number137875
License Number StateAK
# 6
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number5012691
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberSP012272
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: