MEDICARE: MS. HOLLY MARIE FRAZIER LMP

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	390200000X	Student in an Organized Health Care Education/Training Program	MA60167911	WA

General Provider Information

NPI Number	:	1548571045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY MARIE FRAZIER LMP

Provider Business Mailing Address
First Line	:	3805 COLLEGE ST SE UNIT 47
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-3582
Country	:	US
Telephone Number	:	360-970-7587
Fax Number	:

Provider Business Practice Location Address
First Line	:	3805 COLLEGE ST SE UNIT 47
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-3582
Country	:	US
Telephone Number	:	360-970-7587
Fax Number	:

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

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	06/30/2010

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