Provider Demographics
NPI:1255806030
Name:FRAGER, EILEEN CATHERINE (FNP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:CATHERINE
Last Name:FRAGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-4830
Mailing Address - Fax:704-316-4831
Practice Address - Street 1:19485 OLD JETTON RD STE 270
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6592
Practice Address - Country:US
Practice Address - Phone:980-488-9740
Practice Address - Fax:980-488-9750
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC163276163W00000X
NC5011110363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse