MEDICARE: MARY FRAZIER NREMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146N00000X	Basic Emergency Medical Technician	58341	OK

General Provider Information

NPI Number	:	1184450439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY FRAZIER NREMT

Provider Business Mailing Address
First Line	:	504 JUDY LN # A
Second Line	:
City	:	TAHLEQUAH
State	:	OK
Zip	:	74464-4214
Country	:	US
Telephone Number	:	918-954-7642
Fax Number	:

Provider Business Practice Location Address
First Line	:	33038 LONG BAY RD
Second Line	:
City	:	WAGONER
State	:	OK
Zip	:	74467-3682
Country	:	US
Telephone Number	:	918-485-9500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	09/12/2024

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