Provider Demographics
NPI:1366932485
Name:FREUDENBERGER, PATRICIA NICOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:NICOLE
Last Name:FREUDENBERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:NICOLE
Other - Last Name:FREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5125 JONESTOWN RD STE 105
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2987
Practice Address - Country:US
Practice Address - Phone:717-943-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty