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NPI Code Detail

MEDICARE: LISA M FRAZIER NP

MEDICARE: LISA M FRAZIER NP
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
1363LF0000XFamily Nurse PractitionerRN204791GA

General Provider Information

NPI Number : 1316560238
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA M FRAZIER NP
Provider Business Mailing Address
First Line : 1014 W FRANKLIN ST
Second Line :
City : SYLVESTER
State : GA
Zip : 31791-1978
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1014 W FRANKLIN ST
Second Line :
City : SYLVESTER
State : GA
Zip : 31791-1978
Country : US
Telephone Number : 229-776-6961
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2020
Last Update Date : 05/27/2020

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