Provider Demographics
NPI:1629223474
Name:FRAZEE, JACQUELINE NAVIN (PT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:NAVIN
Last Name:FRAZEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 WELLINGTON DR N
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-9432
Mailing Address - Country:US
Mailing Address - Phone:315-256-7339
Mailing Address - Fax:
Practice Address - Street 1:3838 WELLINGTON DR N
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-9432
Practice Address - Country:US
Practice Address - Phone:315-256-7339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021155-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker