Individual
MRS. AMANDA MORGAN FREEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1010 SPRUCE ST 2ND FL AREA 3, ESPANOLA, NM 87532-2724
(505) 367-0340
(505) 367-0346
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 367-0340
(505) 367-0346
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2024-0048
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
926580505
—
MD
05
—
926580507
—
MD
Enumeration date
01/13/2012
Last updated
07/03/2024
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