Provider Demographics
NPI:1326391079
Name:FRASER, LANA ABIOLA (CNA)
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:ABIOLA
Last Name:FRASER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-4212
Mailing Address - Country:US
Mailing Address - Phone:770-728-0661
Mailing Address - Fax:
Practice Address - Street 1:840 OAKHILL ROAD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016
Practice Address - Country:US
Practice Address - Phone:770-728-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide