1073532271 NPI number — RAMONA L FRASER RN N24954

Table of content: RAMONA L FRASER RN N24954 (NPI 1073532271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073532271 NPI number — RAMONA L FRASER RN N24954

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRASER
Provider First Name:
RAMONA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN N24954
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073532271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAPWAI
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83540-0367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-843-2271
Provider Business Mailing Address Fax Number:
208-843-2658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 BEVER GRADE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAPWAI
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-843-2271
Provider Business Practice Location Address Fax Number:
208-843-2658
Provider Enumeration Date:
07/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  N24954 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)