Healthcare Provider Details

I. General information

NPI: 1366958373
Provider Name (Legal Business Name): SUSAN LYNN FRAZIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W MAIN ST
ALBION IL
62806-1006
US

IV. Provider business mailing address

4241 HIGHWAY 14 W
CHRISTOPHER IL
62822-1037
US

V. Phone/Fax

Practice location:
  • Phone: 618-445-2287
  • Fax:
Mailing address:
  • Phone: 618-724-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041447440
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: