Provider Demographics
NPI:1699007153
Name:LONNIE F FRAZIER
Entity Type:Organization
Organization Name:LONNIE F FRAZIER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:325-212-4420
Mailing Address - Street 1:709 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-4515
Mailing Address - Country:US
Mailing Address - Phone:325-212-4420
Mailing Address - Fax:325-617-4481
Practice Address - Street 1:709 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-4515
Practice Address - Country:US
Practice Address - Phone:325-212-4420
Practice Address - Fax:325-617-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX540262251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management