Healthcare Provider Details

I. General information

NPI: 1790277663
Provider Name (Legal Business Name): KIMBERLY DAWN FREITAS MSN, RNC-MNN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 09/06/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 RIVERMONT AVE
LYNCHBURG VA
24503-2030
US

IV. Provider business mailing address

3300 RIVERMONT AVE
LYNCHBURG VA
24503-2030
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3000
  • Fax:
Mailing address:
  • Phone: 434-401-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001223303
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-108348
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024179612
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: