Basic Information
| Provider Information | |||||||||
| NPI: | 1508820440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | PAYNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FREEMAN | ||||||||
| OtherFirstName: | ANDREA | ||||||||
| OtherMiddleName: | RENEE | ||||||||
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| OtherCredential: | CRNA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2151 OLD ROCKY RIDGE RD STE 106 | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA HILLS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352167251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059891080 | ||||||||
| FaxNumber: | 2059891087 | ||||||||
| Practice Location | |||||||||
| Address1: | 3316 HIGHWAY 280 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDER CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350103369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563297100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 01/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1-047484 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 430036754 | 01 | AL | PALMETTO | OTHER | 595253125A | 01 | AL | GA CAID | OTHER | 000032116 | 05 | AL | MEDICAID |