Provider Demographics
NPI:1750809612
Name:LUIS, MARCIA FRAZAO (FNP)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:FRAZAO
Last Name:LUIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:MARCIA
Other - Middle Name:FRAZAO
Other - Last Name:LUIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:800 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3300
Mailing Address - Country:US
Mailing Address - Phone:864-234-5800
Mailing Address - Fax:
Practice Address - Street 1:800 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3300
Practice Address - Country:US
Practice Address - Phone:864-234-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21263363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health