MEDICARE: NICOLE FRAKES

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	363A00000X	Physician Assistant	57477	CA

General Provider Information

NPI Number	:	1619511706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE FRAKES

Provider Business Mailing Address
First Line	:	750 HIGHLAND AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-2221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 HIGHLAND AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-2221
Country	:	US
Telephone Number	:	608-263-4900
Fax Number	:

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

Provider Enumeration Date	:	10/31/2019
Last Update Date	:	11/08/2019

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Directions to “ NICOLE FRAKES ” Practice Location

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