Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LM245 | CA |
NPI | 1003353491 |
---|---|
Provider Name | Bethany Joy Freeling |
First Address | Richmond, CA 94805-1105 |
Second Address | Richmond, CA 94805-1105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2017 |
Last Update Date | 24/01/2017 |