Provider Demographics
NPI:1376818856
Name:FRAZEE, HANNAH P (PA)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:P
Last Name:FRAZEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:M
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:ATTENTION ZOOMCARE
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14617 SE MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-1416
Practice Address - Country:US
Practice Address - Phone:503-962-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA163028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500703586Medicaid
OR500703586Medicaid
ORR186871Medicare PIN
ORR186872Medicare PIN