MEDICARE: MS. BARBARA FRAZEY L.P.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LP041830	AZ

General Provider Information

NPI Number	:	1982248399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA FRAZEY L.P.N.

Provider Business Mailing Address
First Line	:	3404 SANTA MARIA RD.
Second Line	:
City	:	GOLDEN VALLEY
State	:	AZ
Zip	:	86413
Country	:	US
Telephone Number	:	928-565-9111
Fax Number	:	928-565-9190

Provider Business Practice Location Address
First Line	:	3404 SANTA MARIA RD.
Second Line	:
City	:	GOLDEN VALLEY
State	:	AZ
Zip	:	86413
Country	:	US
Telephone Number	:	928-565-9111
Fax Number	:	928-565-9190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	10/30/2019

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