Provider Demographics
NPI:1437566122
Name:FRASER, JEANETTE LUELLA (APRN)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:LUELLA
Last Name:FRASER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24489 COUNTY ROAD 54
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-9757
Mailing Address - Country:US
Mailing Address - Phone:970-689-9925
Mailing Address - Fax:
Practice Address - Street 1:24489 COUNTY ROAD 54
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-9757
Practice Address - Country:US
Practice Address - Phone:970-689-9925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0017024-CNS364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health