Individual
FREDA ANN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
112 W JEFFERSON BLVD, SOUTH BEND, IN 46601-1923
(574) 546-1900
(574) 546-1999
Mailing address
112 W JEFFERSON BLVD, SOUTH BEND, IN 46601-1923
(574) 546-1900
(574) 546-1999
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
209.005685
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
71001497
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041.335636
RN LICENSE NUMBER
IL
01
—
209.005685
APN LICENSE NUMBER
IL
01
—
28104924A
RN LICENSE NUMBER
IN
01
—
71001497A
APN LICENSE NUMBER
IN
Enumeration date
07/31/2006
Last updated
09/08/2016
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