Provider Demographics
NPI:1114804978
Name:FRAZIERWYNN, DAPHNEY M
Entity type:Individual
Prefix:
First Name:DAPHNEY
Middle Name:M
Last Name:FRAZIERWYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 9TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1304
Mailing Address - Country:US
Mailing Address - Phone:456-637-3745
Mailing Address - Fax:
Practice Address - Street 1:1510 9TH ST APT 1
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1304
Practice Address - Country:US
Practice Address - Phone:456-637-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA605391162374U00000X, 372600000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant