Provider Demographics
NPI:1144381823
Name:FRAZER, AMY LYNNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNNE
Last Name:FRAZER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2570 FOXFIELD RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1406
Mailing Address - Country:US
Mailing Address - Phone:630-584-1950
Mailing Address - Fax:630-584-8994
Practice Address - Street 1:2570 FOXFIELD RD
Practice Address - Street 2:STE 100
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174
Practice Address - Country:US
Practice Address - Phone:630-584-1950
Practice Address - Fax:630-584-8994
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL85002913363AM0700X
IL085002913363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
244610002Medicare UPIN