Provider Demographics
NPI:1083211759
Name:FRANDSEN, CHANISE TIARE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHANISE
Middle Name:TIARE
Last Name:FRANDSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHANISE
Other - Middle Name:TIARE
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-724-8180
Mailing Address - Fax:281-336-1171
Practice Address - Street 1:600 N KOBAYASHI STE 208
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4841
Practice Address - Country:US
Practice Address - Phone:281-724-8180
Practice Address - Fax:281-336-1171
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical