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General NPI Number Information
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NPI Number | 1205576055
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Entity Type | Individual
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Provider Name | SHANNON FRAZIER
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Gender | Female
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 1380 DUBLIN RD
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City | COLUMBUS
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State | OH
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Zip | 43215-1025
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Country | US
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Telephone | 614-488-7117
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Fax |
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Provider Business Mailing Address
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Address Line | 1076 JOSEPHINE CLAIRE WAY APT 301
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City | COLUMBUS
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State | OH
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Zip | 43220-3367
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Country | US
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Telephone | 937-241-3801
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.486718
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License Number State | OH
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