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General NPI Number Information
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NPI Number | 1891461927
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Entity Type | Individual
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Provider Name | GAYLE L FREEMAN RN
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Gender | Female
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 43 W PRAIRIE SHOPPING CTR
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City | HAYDEN
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State | ID
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Zip | 83835-9854
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Country | US
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Telephone | 208-772-2774
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Fax |
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Provider Business Mailing Address
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Address Line | 25 E MARYANNA LN
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City | HAYDEN
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State | ID
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Zip | 83835-5162
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Country | US
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Telephone | 208-277-7354
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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 | N-35243
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License Number State | ID
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