Healthcare Provider Details

I. General information

NPI: 1376946756
Provider Name (Legal Business Name): AMI FREEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 44TH ST
LUBBOCK TX
79414-3215
US

IV. Provider business mailing address

5005 44TH ST
LUBBOCK TX
79414-3215
US

V. Phone/Fax

Practice location:
  • Phone: 806-281-4636
  • Fax:
Mailing address:
  • Phone: 806-281-4636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number780771
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number780771
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: