Healthcare Provider Details

I. General information

NPI: 1548840960
Provider Name (Legal Business Name): MONICA FRAZIER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 HIGHWAY 1207
DEVILLE LA
71328-9574
US

IV. Provider business mailing address

626 HIGHWAY 1207
DEVILLE LA
71328-9574
US

V. Phone/Fax

Practice location:
  • Phone: 318-880-6473
  • Fax:
Mailing address:
  • Phone: 318-880-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number215627
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: