Provider Demographics
NPI:1629195243
Name:FRASER, LESLEA ELDRIDGE (LPN)
Entity Type:Individual
Prefix:
First Name:LESLEA
Middle Name:ELDRIDGE
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 1:2001 SE JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5861
Mailing Address - Country:US
Mailing Address - Phone:772-283-3076
Mailing Address - Fax:772-283-3076
Practice Address - Street 1:2001 SE JACKSON ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5861
Practice Address - Country:US
Practice Address - Phone:772-283-3076
Practice Address - Fax:772-283-3076
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1186941164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse