Provider Demographics
NPI:1881300564
Name:FRAZIER, KATHRYN (FNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9041
Mailing Address - Country:US
Mailing Address - Phone:847-356-5575
Mailing Address - Fax:847-356-1792
Practice Address - Street 1:2031 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-9041
Practice Address - Country:US
Practice Address - Phone:847-356-5575
Practice Address - Fax:847-356-1792
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024550208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics