=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811786072
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEAN R FREITAS FNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2025
-----------------------------------------------------
Last Update Date | 05/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6354 WALKER LN STE 300
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22310-3252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-533-6276
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12011 CORRAL DR
-----------------------------------------------------
City | FAIRFAX STATION
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22039-1512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-626-7228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 0024189757
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------