Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | APRN.CNP.026474 | OH |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | APRN.CNP.026474 | OH |
NPI | 1316574528 |
---|---|
Provider Name | Jodie Marie Frazier |
First Address | Columbus, OH 43205-2664 |
Second Address | Lima, OH 45801-4602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2020 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0400741 | (05) | OH |