Healthcare Provider Details

I. General information

NPI: 1255806030
Provider Name (Legal Business Name): EILEEN CATHERINE FRAGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19485 OLD JETTON RD STE 270
CORNELIUS NC
28031-6592
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 980-488-9740
  • Fax: 980-488-9750
Mailing address:
  • Phone: 704-316-4830
  • Fax: 704-316-4831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number163276
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5011110
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: