Healthcare Provider Details

I. General information

NPI: 1427786532
Provider Name (Legal Business Name): JONATHAN FRAZIER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12410 E SINTO AVE STE 101
SPOKANE VALLEY WA
99216-2258
US

IV. Provider business mailing address

601 W 5TH AVE STE 400
SPOKANE WA
99204-2715
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-2955
  • Fax: 509-789-2975
Mailing address:
  • Phone: 509-344-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61337893
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61337893
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: