=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124227244
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRACEANN A FREEMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2007
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 W 1ST ST
-----------------------------------------------------
City | WAPATO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98951-1108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-887-4111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 15645
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89114-5645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-579-3298
-----------------------------------------------------
Fax | 702-667-4689
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APN000955
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AP61599120
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------