Provider Demographics
NPI:1043502446
Name:FREEMAN, STEPANIDA (MD)
Entity type:Individual
Prefix:
First Name:STEPANIDA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10624 S EASTERN AVE STE A-873
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-478-5111
Mailing Address - Fax:
Practice Address - Street 1:3039 W HORIZON RIDGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4193
Practice Address - Country:US
Practice Address - Phone:702-478-5111
Practice Address - Fax:702-602-9012
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18298207V00000X
OH57.013402207V00000X
KYIP1173207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid
AZPENDINGOtherDEA
AZPENDINGMedicaid