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General NPI Number Information
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NPI Number | 1295494326
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Entity Type | Individual
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Provider Name | SUSAN FREE
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Gender | Female
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 4401 W WESTERN AVE STE C
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City | SOUTH BEND
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State | IN
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Zip | 46619-2645
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Country | US
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Telephone | 574-725-7006
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Fax | 574-807-9614
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Provider Business Mailing Address
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Address Line | PO BOX 708760
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City | SANDY
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State | UT
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Zip | 84070-8717
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Country | US
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Telephone | 801-352-9500
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Fax | 801-352-7976
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 28216649A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28216649A
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License Number State | IN
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