Provider Demographics
NPI:1447609672
Name:FRASER, KAMILAH SONIA (LPN)
Entity Type:Individual
Prefix:
First Name:KAMILAH
Middle Name:SONIA
Last Name:FRASER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 QUINCY ST
Mailing Address - Street 2:1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1314
Mailing Address - Country:US
Mailing Address - Phone:347-743-3523
Mailing Address - Fax:718-398-4742
Practice Address - Street 1:136 QUINCY ST
Practice Address - Street 2:1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1314
Practice Address - Country:US
Practice Address - Phone:347-743-3523
Practice Address - Fax:718-398-4742
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2864561164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse