Healthcare Provider Details

I. General information

NPI: 1255152740
Provider Name (Legal Business Name): MONET FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 MUSTANG TRL STE 101
VIRGINIA BEACH VA
23452-7517
US

IV. Provider business mailing address

5745 AMBERBROOKE ARCH APT 301
VIRGINIA BEACH VA
23464-9128
US

V. Phone/Fax

Practice location:
  • Phone: 757-981-2560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: