Provider Demographics
NPI:1346716610
Name:FRAZIER, CAROLYN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23077 GREENFIELD RD STE 156
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3770
Mailing Address - Country:US
Mailing Address - Phone:313-405-3195
Mailing Address - Fax:
Practice Address - Street 1:23077 GREENFIELD RD STE 156
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3770
Practice Address - Country:US
Practice Address - Phone:586-257-0680
Practice Address - Fax:586-863-4680
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704144422363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care