Provider Demographics
NPI:1184993099
Name:FRASHER, RENE ANN (DHSC, PA-C)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:ANN
Last Name:FRASHER
Suffix:
Gender:F
Credentials:DHSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E MAIN ST
Mailing Address - Street 2:VA ILLIANA HCS
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832
Mailing Address - Country:US
Mailing Address - Phone:217-554-5065
Mailing Address - Fax:217-554-4842
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-554-5065
Practice Address - Fax:217-554-4842
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA524363A00000X
AK1030363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1578093Medicaid