Provider Demographics
NPI:1205572948
Name:FRAZIER, JESSICA NICOLE (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RALDEN CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1461
Mailing Address - Country:US
Mailing Address - Phone:800-784-2464
Mailing Address - Fax:
Practice Address - Street 1:13 RALDEN CT
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1461
Practice Address - Country:US
Practice Address - Phone:800-784-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212931163W00000X, 163WH0200X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health