Provider Demographics
NPI:1548685076
Name:LETANG-FREEMAN, SIMONE
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:LETANG-FREEMAN
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 1:4001 RAPHUNE HILL RD STE 106
Mailing Address - Street 2:ELITE MEDICAL SUPPLY
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2905
Mailing Address - Country:US
Mailing Address - Phone:340-779-8116
Mailing Address - Fax:
Practice Address - Street 1:4001 RAPHUNE HILL RD STE 106
Practice Address - Street 2:ELITE MEDICAL SUPPLY
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2905
Practice Address - Country:US
Practice Address - Phone:340-779-8116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1-13417-1L332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment