Healthcare Provider Details

I. General information

NPI: 1356602999
Provider Name (Legal Business Name): CRYSTAL YVETTE FRAZIER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4866 S WASHINGTON RD APT 4
SAGINAW MI
48601-7207
US

IV. Provider business mailing address

4866 S WASHINGTON RD APT 4
SAGINAW MI
48601-7207
US

V. Phone/Fax

Practice location:
  • Phone: 989-475-2777
  • Fax:
Mailing address:
  • Phone: 989-475-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703099461
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: