Provider Demographics
NPI:1699167908
Name:FRAZIER, MARITA
Entity type:Individual
Prefix:
First Name:MARITA
Middle Name:
Last Name:FRAZIER
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 1:302 JEFFREY PL
Mailing Address - Street 2:APT. #104
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-5939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 JEFFREY PL
Practice Address - Street 2:APT. #104
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-5939
Practice Address - Country:US
Practice Address - Phone:470-723-4215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0044489163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse