Provider Demographics
NPI:1831311422
Name:FRAZIER, CHERYL ANNETTE (LPN)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANNETTE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 DEWEY EXT
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648
Mailing Address - Country:US
Mailing Address - Phone:740-820-2995
Mailing Address - Fax:
Practice Address - Street 1:763 DEWEY EXT
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648
Practice Address - Country:US
Practice Address - Phone:740-820-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN118393164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2618715Medicaid