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General NPI Number Information
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NPI Number | 1417010315
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Entity Type | Individual
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Provider Name | DEANNA LATRISE FREEMAN NP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 4160 JOHN R ST STE 510
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City | DETROIT
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State | MI
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Zip | 48201-2021
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Country | US
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Telephone | 313-993-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 24321 TAMARACK CIR
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City | SOUTHFIELD
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State | MI
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Zip | 48075-6182
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Country | US
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Telephone | 248-595-1054
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704218153
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704218153
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License Number State | MI
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