Basic Information
| Provider Information | |||||||||
| NPI: | 1134235906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAIR | ||||||||
| FirstName: | CECILIA | ||||||||
| MiddleName: | FRAZIER | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP,RN,MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 CORPORATE WOODS | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146231467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854633100 | ||||||||
| FaxNumber: | 5854633105 | ||||||||
| Practice Location | |||||||||
| Address1: | 1024 LEXINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123095602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183460072 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F334210 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 4127165 | 01 | NY | MVP HEALTHCARE | OTHER | 000407563002 | 01 | NY | BSNENY | OTHER | 82336 | 01 | NY | GHI/HMO | OTHER | 02501760 | 05 | NY | MEDICAID |