1962495929 NPI number — MISS CAROLYN MARY FREED RN, MN, MSN, ARNP

Table of content: MISS CAROLYN MARY FREED RN, MN, MSN, ARNP (NPI 1962495929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962495929 NPI number — MISS CAROLYN MARY FREED RN, MN, MSN, ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREED
Provider First Name:
CAROLYN
Provider Middle Name:
MARY
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RN, MN, MSN, ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREED-ALBEE
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, MSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962495929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1329 56TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98203-5919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-407-0590
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1630 GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYSVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98270-4302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-653-3500
Provider Business Practice Location Address Fax Number:
360-657-3268
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP30005645 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: RN00112300 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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