Provider Demographics
NPI:1588961312
Name:FRAZOR, JENNIFER SARA
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SARA
Last Name:FRAZOR
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 1:133 BATESVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1182
Mailing Address - Country:US
Mailing Address - Phone:864-607-0701
Mailing Address - Fax:
Practice Address - Street 1:125 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4812
Practice Address - Country:US
Practice Address - Phone:864-675-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC99453163W00000X
SC17476367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse