Provider Demographics
NPI:1679776744
Name:FREAS, NANCY EILEEN
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:EILEEN
Last Name:FREAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 CATALINA DRIVE
Mailing Address - Street 2:D
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:740-403-9475
Mailing Address - Fax:
Practice Address - Street 1:92 OREGON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3578
Practice Address - Country:US
Practice Address - Phone:740-403-9475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2436028Medicaid