MEDICARE: SHANA MELINDA FREEMAN NURSE PRACTITIONER

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5014209	NC
2	363LW0102X	Women's Health Nurse Practitioner	5014209	NC

General Provider Information

NPI Number	:	1235714510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA MELINDA FREEMAN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1025 VINEHAVEN DR NE
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-2439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 VINEHAVEN DR NE
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-2439
Country	:	US
Telephone Number	:	704-918-1343
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	04/08/2026

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