Provider Demographics
NPI:1316635196
Name:FRYER, DESIREE DENISE
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:DENISE
Last Name:FRYER
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 1:3936 W 100 S
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-8103
Mailing Address - Country:US
Mailing Address - Phone:435-559-1472
Mailing Address - Fax:
Practice Address - Street 1:1338 E 600 S
Practice Address - Street 2:
Practice Address - City:NEW HARMONY
Practice Address - State:UT
Practice Address - Zip Code:84757
Practice Address - Country:US
Practice Address - Phone:435-865-1437
Practice Address - Fax:435-865-1439
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program