Provider Demographics
NPI:1083201230
Name:FRAZIER, TAILER ANNE
Entity Type:Individual
Prefix:
First Name:TAILER
Middle Name:ANNE
Last Name:FRAZIER
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 1:230 W 200 S # 142
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1337
Mailing Address - Country:US
Mailing Address - Phone:801-433-2595
Mailing Address - Fax:
Practice Address - Street 1:230 W 200 S # 142
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1337
Practice Address - Country:US
Practice Address - Phone:801-433-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist