Provider Demographics
NPI:1174072748
Name:FRAILEY, LOIS (LPN)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:FRAILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 81
Mailing Address - Street 2:
Mailing Address - City:CAVE IN ROCK
Mailing Address - State:IL
Mailing Address - Zip Code:62919-9719
Mailing Address - Country:US
Mailing Address - Phone:618-841-1247
Mailing Address - Fax:618-289-4732
Practice Address - Street 1:RR 1 BOX 81
Practice Address - Street 2:
Practice Address - City:CAVE IN ROCK
Practice Address - State:IL
Practice Address - Zip Code:62919-9719
Practice Address - Country:US
Practice Address - Phone:618-841-1247
Practice Address - Fax:618-289-4732
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.081961164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse