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General NPI Number Information
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NPI Number | 1194451971
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Entity Type | Individual
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Provider Name | SAMUEL FRAZIER APRN, CNS
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Gender | Male
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 24900 SE STARK ST STE 109
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City | GRESHAM
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State | OR
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Zip | 97030-3381
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Country | US
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Telephone | 503-413-7162
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Fax |
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Provider Business Mailing Address
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Address Line | 2603 CARLOW DR
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City | AUSTIN
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State | TX
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Zip | 78745-4346
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Country | US
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Telephone | 512-507-6664
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 1087151
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 10037912
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License Number State | OR
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