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General NPI Number Information
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NPI Number | 1417131889
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Entity Type | Individual
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Provider Name | MICHELLE R FREEMAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK RD CDW-EM, DEPT OF EM
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City | PORTLAND
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State | OR
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Zip | 97239-3098
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Country | US
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Telephone | 503-494-7008
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Fax | 503-494-4997
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK RD OHSU, DEPT OF EMERGENCY MEDICINE, CDW-EM
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City | PORTLAND
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State | OR
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Zip | 97239
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Country | US
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Telephone | 503-494-7008
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Fax | 503-494-4997
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2010-0052
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA01322
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License Number State | OR
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