Basic Information
| Provider Information | |||||||||
| NPI: | 1932824190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | BIANCA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MSN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 645 PITCAIRN ST | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925067572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259397525 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6926 BROCKTON AVE STE 8 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925063804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774147739 | ||||||||
| FaxNumber: | 8446820372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2022 | ||||||||
| LastUpdateDate: | 10/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95022564 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.