Healthcare Provider Details

I. General information

NPI: 1700347374
Provider Name (Legal Business Name): HEATHER FREEMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER LEJEUNE

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W BUTLER RD
GREENVILLE SC
29607-4833
US

IV. Provider business mailing address

PO BOX 721
MAULDIN SC
29662-0721
US

V. Phone/Fax

Practice location:
  • Phone: 864-299-1990
  • Fax:
Mailing address:
  • Phone: 864-299-1990
  • Fax: 864-299-9123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22689
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: