Provider Demographics
NPI:1043219462
Name:FRAZIER, CHARLANE A (WHCNP)
Entity Type:Individual
Prefix:MS
First Name:CHARLANE
Middle Name:A
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 JEROME PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-7101
Mailing Address - Country:US
Mailing Address - Phone:541-659-0902
Mailing Address - Fax:541-474-0638
Practice Address - Street 1:160 NW FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1086
Practice Address - Country:US
Practice Address - Phone:541-474-2784
Practice Address - Fax:541-474-0638
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450129363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR110215Medicare ID - Type Unspecified
ORP38116Medicare UPIN