Individual
MARY LOU FREITAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
324 4TH ST, MYRTLE POINT, OR 97458-1074
(541) 572-2111
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2099
(541) 267-5151
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
202010537NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500789478
—
OR
Enumeration date
01/07/2021
Last updated
07/08/2021
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