Provider Demographics
NPI:1235724691
Name:FRAISE, MORGAN LEE
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:LEE
Last Name:FRAISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HOUGHTON 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DONNELLSON
Mailing Address - State:IA
Mailing Address - Zip Code:52625-9643
Mailing Address - Country:US
Mailing Address - Phone:319-470-6015
Mailing Address - Fax:
Practice Address - Street 1:3200 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4104
Practice Address - Country:US
Practice Address - Phone:515-271-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program