Healthcare Provider Details

I. General information

NPI: 1417006081
Provider Name (Legal Business Name): LA-TISHA FRAZIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST STE 824
HONOLULU HI
96826-1032
US

IV. Provider business mailing address

1319 PUNAHOU ST STE 824
HONOLULU HI
96826-1032
US

V. Phone/Fax

Practice location:
  • Phone: 808-203-6532
  • Fax: 808-955-2174
Mailing address:
  • Phone: 808-203-6532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4353P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3004353
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD-24448
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: