Healthcare Provider Details

I. General information

NPI: 1336697473
Provider Name (Legal Business Name): RACHEL OSWALD FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 N UNIVERSITY AVE #250
PROVO UT
84604-6683
US

IV. Provider business mailing address

124 W 2975 N
LEHI UT
84043-3820
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-9625
  • Fax: 801-374-9690
Mailing address:
  • Phone: 507-319-5293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9903820-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: