1457351751 NPI number — MS. JANIS LYN FRAZEE RNC MSN

Table of content: MS. JANIS LYN FRAZEE RNC MSN (NPI 1457351751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457351751 NPI number — MS. JANIS LYN FRAZEE RNC MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRAZEE
Provider First Name:
JANIS
Provider Middle Name:
LYN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RNC MSN
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:
1457351751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7426 S ROSINSKI RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49621-9605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-228-7173
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6051 FRANKFORT HWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BENZONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49616-9558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-882-2230
Provider Business Practice Location Address Fax Number:
231-882-2204
Provider Enumeration Date:
07/28/2005

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: 363LW0102X , with the licence number:  4704124608 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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