Healthcare Provider Details

I. General information

NPI: 1851753107
Provider Name (Legal Business Name): IRENE JAMES-FRAZER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1494 LAKE MURRAY BLVD FL 2
COLUMBIA SC
29212-8697
US

IV. Provider business mailing address

PO BOX 291752
COLUMBIA SC
29229-0030
US

V. Phone/Fax

Practice location:
  • Phone: 803-764-1230
  • Fax:
Mailing address:
  • Phone: 803-260-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number19956
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number19956
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number19956
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: