Healthcare Provider Details

I. General information

NPI: 1548685076
Provider Name (Legal Business Name): SIMONE LETANG-FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 RAPHUNE HILL RD STE 106 ELITE MEDICAL SUPPLY
ST THOMAS VI
00802-2905
US

IV. Provider business mailing address

4001 RAPHUNE HILL RD STE 106 ELITE MEDICAL SUPPLY
ST THOMAS VI
00802-2905
US

V. Phone/Fax

Practice location:
  • Phone: 340-779-8116
  • Fax:
Mailing address:
  • Phone: 340-779-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1-13417-1L
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: