Healthcare Provider Details

I. General information

NPI: 1982868956
Provider Name (Legal Business Name): DONNA SUSAN FREEBORN FNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N 1800 W
MAPLETON UT
84664-3138
US

IV. Provider business mailing address

PO BOX 453
SPRINGVILLE UT
84663-0453
US

V. Phone/Fax

Practice location:
  • Phone: 801-489-1164
  • Fax:
Mailing address:
  • Phone: 801-489-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number367022-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number367022-4402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: