Provider Demographics
NPI:1134841794
Name:FRAZIER, THERESA ISADORE (FNP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ISADORE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CASTLEBURY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7566
Mailing Address - Country:US
Mailing Address - Phone:803-553-3632
Mailing Address - Fax:
Practice Address - Street 1:230 CASTLEBURY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7566
Practice Address - Country:US
Practice Address - Phone:803-553-3632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily