MEDICARE: MRS. PAMELA RENEE 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	163WC1500X	Community Health Registered Nurse	648112	TX
2	163WM0102X	Maternal Newborn Registered Nurse	648112	TX
3	163WW0101X	Ambulatory Women's Health Care Registered Nurse	648112	TX
4	163WX0003X	Inpatient Obstetric Registered Nurse	648112	TX

General Provider Information

NPI Number	:	1770735227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA RENEE FREEMAN RN

Provider Business Mailing Address
First Line	:	4944 MARSH HARRIER AVE
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-3057
Country	:	US
Telephone Number	:	972-602-9822
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 COLORADO BLVD
Second Line	:	318
City	:	DENVER
State	:	CO
Zip	:	80206-4084
Country	:	US
Telephone Number	:	866-801-9492
Fax Number	:	800-539-0098

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

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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