Healthcare Provider Details

I. General information

NPI: 1376818856
Provider Name (Legal Business Name): HANNAH P FRAZEE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH M POWELL

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14617 SE MCLOUGHLIN BLVD
MILWAUKIE OR
97267-1416
US

IV. Provider business mailing address

PO BOX 3158 ATTENTION ZOOMCARE
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-962-1782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA163028
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: