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NPI Code Detail

MEDICARE: FREELAND PRIMARY CARE PLLC

MEDICARE: FREELAND PRIMARY CARE PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner
2207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1043557333
Entity Type Code : Organization
Provider Name (Legal Business Name) : FREELAND PRIMARY CARE PLLC
Provider Business Mailing Address
First Line : PO BOX 935
Second Line :
City : FREELAND
State : WA
Zip : 98249-0935
Country : US
Telephone Number : 360-331-3343
Fax Number : 360-331-3373
Provider Business Practice Location Address
First Line : 5577 VANBARR PL
Second Line :
City : FREELAND
State : WA
Zip : 98249-9555
Country : US
Telephone Number : 360-331-3343
Fax Number : 360-331-3373
Authorized Official
Title or Position : PRACTICE MANAGER
Name : KIMBERLY JOHNSON
Credential :
Telephone Number : 360-331-3343
Provider Enumeration Date : 01/07/2013
Last Update Date : 06/12/2024

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5508 HARBOR AVE.
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Directions to “FREELAND PRIMARY CARE PLLC ” Practice Location

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