Provider Demographics
NPI:1366213837
Name:FRAZIER, SAMANTHA-ROSE LEE (APRN, CNM)
Entity type:Individual
Prefix:
First Name:SAMANTHA-ROSE
Middle Name:LEE
Last Name:FRAZIER
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Gender:F
Credentials:APRN, CNM
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Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5641
Practice Address - Street 1:975 RYLAND ST STE 105
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1668
Practice Address - Country:US
Practice Address - Phone:775-982-5640
Practice Address - Fax:775-982-5641
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV873971367A00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife