Provider Demographics
NPI:1508114562
Name:FRAZIER, NINA (LPN)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9189 STATE ROUTE 19
Mailing Address - Street 2:
Mailing Address - City:CANEADEA
Mailing Address - State:NY
Mailing Address - Zip Code:14717-8708
Mailing Address - Country:US
Mailing Address - Phone:585-301-6441
Mailing Address - Fax:
Practice Address - Street 1:9189 STATE ROUTE 19
Practice Address - Street 2:
Practice Address - City:CANEADEA
Practice Address - State:NY
Practice Address - Zip Code:14717-8708
Practice Address - Country:US
Practice Address - Phone:585-301-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-24
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275507164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse