Provider Demographics
NPI:1902483894
Name:FRAZIER, HAVEN NICOLE (DO)
Entity Type:Individual
Prefix:
First Name:HAVEN
Middle Name:NICOLE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W CHARLESTON BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2302
Mailing Address - Country:US
Mailing Address - Phone:702-671-2385
Mailing Address - Fax:702-671-2333
Practice Address - Street 1:MIKE O'CALLAGHAN MILITARY MEDICAL CENTER
Practice Address - Street 2:4700 LAS VEGAS BLVD N
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191
Practice Address - Country:US
Practice Address - Phone:702-653-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL1746390200000X
VA0102207548207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program