Healthcare Provider Details

I. General information

NPI: 1124862289
Provider Name (Legal Business Name): DANIELLE PAIGE FRAZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE MAULUCCI

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 WISHARD BLVD
INDIANAPOLIS IN
46202-4163
US

IV. Provider business mailing address

PO BOX 778912
CHICAGO IL
60677-8912
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-4846
  • Fax: 317-948-7577
Mailing address:
  • Phone: 317-777-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number74000682A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: