Provider Demographics
NPI:1942544846
Name:FRAIN, ROXANN (CRNP)
Entity Type:Individual
Prefix:
First Name:ROXANN
Middle Name:
Last Name:FRAIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 BLACK ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-3147
Mailing Address - Country:US
Mailing Address - Phone:610-792-2224
Mailing Address - Fax:610-792-4026
Practice Address - Street 1:1600 BLACK ROCK RD
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-3147
Practice Address - Country:US
Practice Address - Phone:610-792-2224
Practice Address - Fax:610-792-4026
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN523920L363L00000X
PASP012220363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA016556OtherPRESCRIPTIVE AUTHORITY
PASP012220OtherCRNP LICENSE
PARN523920LOtherNURSING LICENSE