Provider Demographics
NPI:1669726584
Name:FREEZE, CHASADY L (CNP)
Entity type:Individual
Prefix:
First Name:CHASADY
Middle Name:L
Last Name:FREEZE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CHASADY
Other - Middle Name:L
Other - Last Name:COON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:745 HASKINS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-1637
Mailing Address - Country:US
Mailing Address - Phone:419-353-7069
Mailing Address - Fax:419-353-7076
Practice Address - Street 1:1039 HASKINS RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9065
Practice Address - Country:US
Practice Address - Phone:419-352-1121
Practice Address - Fax:419-352-1179
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13674-NP364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0076970Medicaid
OHH162380Medicare PIN