Provider Demographics
NPI:1215628862
Name:FRAZIER, FONDA RONDELLE I
Entity type:Individual
Prefix:MISS
First Name:FONDA
Middle Name:RONDELLE
Last Name:FRAZIER
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15697-1637
Mailing Address - Country:US
Mailing Address - Phone:724-925-1160
Mailing Address - Fax:
Practice Address - Street 1:311 DEPOT ST
Practice Address - Street 2:
Practice Address - City:YOUNGWOOD
Practice Address - State:PA
Practice Address - Zip Code:15697-1637
Practice Address - Country:US
Practice Address - Phone:724-925-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA24066646172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver