Provider Demographics
NPI:1396395208
Name:FRASER, VYNETTE FALKON
Entity Type:Individual
Prefix:MRS
First Name:VYNETTE
Middle Name:FALKON
Last Name:FRASER
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 1:175 W. 90TH STREET
Mailing Address - Street 2:#19J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1253
Mailing Address - Country:US
Mailing Address - Phone:212-873-0317
Mailing Address - Fax:
Practice Address - Street 1:175 W. 90TH STREET
Practice Address - Street 2:#19J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1253
Practice Address - Country:US
Practice Address - Phone:212-873-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider