Provider Demographics
NPI:1093411209
Name:FRASCA, COREY ROBERT (SRNA, RN)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:ROBERT
Last Name:FRASCA
Suffix:
Gender:M
Credentials:SRNA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 PINE TREE POINT DR
Mailing Address - Street 2:
Mailing Address - City:HEATHSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22473-2608
Mailing Address - Country:US
Mailing Address - Phone:804-405-9181
Mailing Address - Fax:
Practice Address - Street 1:1201 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5026
Practice Address - Country:US
Practice Address - Phone:804-828-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001284981163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine