Provider Demographics
NPI:1730657909
Name:FRAZIER, CONSTANCE (RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2566 HAYMAKER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3555
Mailing Address - Country:US
Mailing Address - Phone:412-858-4474
Mailing Address - Fax:412-858-3033
Practice Address - Street 1:2566 HAYMAKER RD STE 101
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3555
Practice Address - Country:US
Practice Address - Phone:412-858-4474
Practice Address - Fax:412-858-3033
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000271133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036328270001Medicaid