Healthcare Provider Details

I. General information

NPI: 1053302778
Provider Name (Legal Business Name): JOANNE ALETHA FREEMAN C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JODI ALETHA FREEMAN C.P.N.P.

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 14TH AVE
LONGVIEW WA
98632-2315
US

IV. Provider business mailing address

784 14TH AVE
LONGVIEW WA
98632-2315
US

V. Phone/Fax

Practice location:
  • Phone: 360-425-6111
  • Fax: 360-636-1297
Mailing address:
  • Phone: 360-425-6111
  • Fax: 360-636-1297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN00120002
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP30003667
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: