Basic Information
Provider Information
NPI: 1306394671
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRELIER
FirstName: ALICIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
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OtherCredential:  
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Mailing Information
Address1: 2589 PUTNAM RD
Address2:  
City: ONTARIO
State: NY
PostalCode: 145199722
CountryCode: US
TelephoneNumber: 5854722713
FaxNumber:  
Practice Location
Address1: 601 ELMWOOD AVE
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146420001
CountryCode: US
TelephoneNumber: 5852752100
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/15/2016
LastUpdateDate: 09/15/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X33 341056NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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