Provider Demographics
NPI:1821414152
Name:FRAZIER, THOMAS (RN)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9616 BRACE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1468
Mailing Address - Country:US
Mailing Address - Phone:313-270-4099
Mailing Address - Fax:313-838-8606
Practice Address - Street 1:9616 BRACE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1468
Practice Address - Country:US
Practice Address - Phone:313-270-4099
Practice Address - Fax:313-838-8606
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704198168163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse