Basic Information
| Provider Information | |||||||||
| NPI: | 1699045823 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | NIKOLE | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 645 ANTELOPE BLVD STE 24 | ||||||||
| Address2: | |||||||||
| City: | RED BLUFF | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960802463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305287650 | ||||||||
| FaxNumber: | 5305287655 | ||||||||
| Practice Location | |||||||||
| Address1: | 645 ANTELOPE BLVD STE 24 | ||||||||
| Address2: | |||||||||
| City: | RED BLUFF | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960802463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305287650 | ||||||||
| FaxNumber: | 5305287655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2012 | ||||||||
| LastUpdateDate: | 01/04/2012 | ||||||||
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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 | 363AM0700X | PA22028 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.