1770852295 NPI number — GINA MARICE FRAZIER LPN, LPC CANDIDATE

Table of content: GINA MARICE FRAZIER LPN, LPC CANDIDATE (NPI 1770852295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770852295 NPI number — GINA MARICE FRAZIER LPN, LPC CANDIDATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRAZIER
Provider First Name:
GINA
Provider Middle Name:
MARICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN, LPC CANDIDATE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770852295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RESOURCE MANAGEMENT
Provider Second Line Business Mailing Address:
210 E. MAIN ST.
Provider Business Mailing Address City Name:
ADA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-436-7211
Provider Business Mailing Address Fax Number:
580-272-5757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OUTPATIENT SERVICES- TISHOMINGO
Provider Second Line Business Practice Location Address:
817 E. 6TH ST.
Provider Business Practice Location Address City Name:
TISHOMINGO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-371-2361
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  L0051911 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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