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General NPI Number Information
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NPI Number | 1659835734
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Entity Type | Individual
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Provider Name | ALISHA LEIGH FREEBURG NP
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Gender | Female
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 9055 SPRINGBROOK DR NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-5841
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Country | US
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Telephone | 763-780-9155
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 CHICAGO AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1321
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Country | US
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Telephone | 612-262-5000
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 1292655
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License Number State | MN
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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 | 6439
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License Number State | MN
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