Provider Demographics
NPI:1962480426
Name:FRAZER, PETER R (CRNA, ARNP)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:R
Last Name:FRAZER
Suffix:
Gender:M
Credentials:CRNA, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2001, 90 SWIFTWATER ROAD
Mailing Address - Street 2:COTTAGE HOSPITAL
Mailing Address - City:WOODSVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03785-2001
Mailing Address - Country:US
Mailing Address - Phone:603-747-9000
Mailing Address - Fax:603-747-0401
Practice Address - Street 1:90 SWIFTWATER ROAD
Practice Address - Street 2:COTTAGE HOSPITAL
Practice Address - City:WOODSVILLE
Practice Address - State:NH
Practice Address - Zip Code:03785-2001
Practice Address - Country:US
Practice Address - Phone:603-747-9000
Practice Address - Fax:603-747-0401
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0204342311363L00000X
NH020434-23367500000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHORE 2057Medicaid
NHORE2057Medicaid
NP4060Medicare Oscar/Certification
NHORE 2057Medicaid
NHR83582Medicare UPIN