MEDICARE: AMI FREEMAN RN

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	163WC0200X	Critical Care Medicine Registered Nurse	780771	TX
2	163WC0400X	Case Management Registered Nurse	780771	TX

General Provider Information

NPI Number	:	1376946756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMI FREEMAN RN

Provider Business Mailing Address
First Line	:	5005 44TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79414-3215
Country	:	US
Telephone Number	:	806-281-4636
Fax Number	:

Provider Business Practice Location Address
First Line	:	5005 44TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79414-3215
Country	:	US
Telephone Number	:	806-281-4636
Fax Number	:

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

Provider Enumeration Date	:	09/30/2014
Last Update Date	:	09/30/2014

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Directions to “ AMI FREEMAN RN” Practice Location

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