Michael A Frazer, LPN

Individual provider Active NPI Registered Nurse · Cass Lake, MN

NPI 1821114810 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1821114810
Entity type
Individual (NPI type 1)
Primary specialty
Registered Nurse 163W00000X
License
L061892-6 (MN)
Practice address
425 7TH St NW
Cass Lake, MN 56633-3360
Phone
(218) 335-3200
NPI assigned
Mar 21, 2007
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
L061892-6MNMDRegistered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X L061892-6 MN Yes

Addresses

Primary practice location

425 7TH St NW
Cass Lake, MN 56633-3360

Mailing address

425 7TH St NW
Cass Lake, MN 56633-3360
Phone (218) 335-3200

Other providers in Cass Lake, MN

All providers in Cass Lake, MN · Registered Nurse in Minnesota

Sources for this page

Verify at the official NPI Registry.