Individual
TIFFANY J FRASURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2845 SIENA HEIGHTS DR, HENDERSON, NV 89052-4153
(702) 617-1227
(702) 492-9574
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 617-1227
(702) 492-9574
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1478
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750702288
—
NV
Enumeration date
12/31/2013
Last updated
02/02/2017
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