Provider Demographics
NPI:1144619164
Name:FRASER, JACQUELINE BEATRICE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:BEATRICE
Last Name:FRASER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:BEATRICE
Other - Last Name:FRASER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:251 E 89TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1417
Mailing Address - Country:US
Mailing Address - Phone:718-451-3570
Mailing Address - Fax:
Practice Address - Street 1:251 E 89TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-1417
Practice Address - Country:US
Practice Address - Phone:718-451-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320997-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse