Basic Information
| Provider Information | |||||||||
| NPI: | 1275695983 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRAZO | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | PNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144561561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157875200 | ||||||||
| FaxNumber: | 3157875221 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144561561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157875100 | ||||||||
| FaxNumber: | 3157875108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2006 | ||||||||
| LastUpdateDate: | 12/05/2011 | ||||||||
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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 | 363LP0200X | F3326901 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | P109381105 | 01 | NY | BLUE CROSS | OTHER | 02073605 | 05 | NY | MEDICAID | 109567DL | 01 | NY | PREFERRED CARE | OTHER |