Healthcare Provider Details

I. General information

NPI: 1902483894
Provider Name (Legal Business Name): HAVEN NICOLE FRAZIER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MDG UNIT 5024
APO AP
96319-5024
US

IV. Provider business mailing address

35 MDG UNIT 5024
APO AP
96319-5024
US

V. Phone/Fax

Practice location:
  • Phone: 315-226-6150
  • Fax:
Mailing address:
  • Phone: 315-226-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0102207548
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: