Provider Demographics
NPI:1679226245
Name:BRAY.FRAZIER, CHARCIE (LPN)
Entity Type:Individual
Prefix:
First Name:CHARCIE
Middle Name:
Last Name:BRAY.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 1:26620 BURG RD # C219
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1000
Mailing Address - Country:US
Mailing Address - Phone:313-815-5091
Mailing Address - Fax:
Practice Address - Street 1:26620 BURG RD # C219
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1000
Practice Address - Country:US
Practice Address - Phone:313-815-5091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703065092164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4703065092OtherLPN CERTIFICATIONS