Healthcare Provider Details

I. General information

NPI: 1518182914
Provider Name (Legal Business Name): ROSEANNA FREEMAN OPA C ST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 02/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN SUITE C-135
DALLAS TX
75230-2571
US

IV. Provider business mailing address

7777 FOREST LN C 135
DALLAS TX
75230-2571
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-5564
  • Fax: 972-566-7556
Mailing address:
  • Phone: 972-566-5564
  • Fax: 972-566-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number056191 - SUR TECH #
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number056191-CERTSURGTECH
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: