Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 300008 | NC |
NPI | 1336227776 |
---|---|
Provider Name | Mrs. Ellen M Freck |
First Address | Weaverville, NC 28787-9377 |
Second Address | Asheville, NC 28801-3020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |