Healthcare Provider Details

I. General information

NPI: 1780538835
Provider Name (Legal Business Name): NICOLE FRAZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 N ASSEMBLY ST
SPOKANE WA
99205-6185
US

IV. Provider business mailing address

4815 N ASSEMBLY ST
SPOKANE WA
99205-6185
US

V. Phone/Fax

Practice location:
  • Phone: 509-552-9749
  • Fax:
Mailing address:
  • Phone: 509-552-9749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number61626326
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: