Black, Freda Ann

Black, Freda Ann is an individual health care provider with primary practice located at 112 W Jefferson Blvd , South Bend IN 46601-1923. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Black, Freda Ann can be contacted via phone (574) 546-1900.

Contact Information

Primary practice address
112 W Jefferson Blvd South Bend IN 46601-1923
Phone: (574) 546-1900
Fax: (574) 546-1999
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 209.005685 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 71001497 Indiana

Profile Details

NPI number 1740296516
LBN Legal business name Black, Freda Ann
Credentials NURSE PRACTITIONER
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 31st, 2006
Last updated Sep 8th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740296516 NPPES
Indiana Other 28104924A RN LICENSE NUMBER
Indiana Other 71001497A RN LICENSE NUMBER
Indiana Other 041.335636 RN LICENSE NUMBER
Indiana Other 209.005685 RN LICENSE NUMBER

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