Provider Demographics
NPI:1730523937
Name:FRAZIER, EDITH ARNETTA (RN)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:ARNETTA
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 AMY LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-2002
Mailing Address - Country:US
Mailing Address - Phone:845-275-2452
Mailing Address - Fax:
Practice Address - Street 1:2119 BRILLANTE DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-8742
Practice Address - Country:US
Practice Address - Phone:845-394-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3014471164W00000X
FL9628719163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse