Provider Demographics
NPI:1821044769
Name:FRAY, CAROL T (APRN - BC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:T
Last Name:FRAY
Suffix:
Gender:F
Credentials:APRN - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06778-2520
Mailing Address - Country:US
Mailing Address - Phone:860-484-4376
Mailing Address - Fax:860-484-4376
Practice Address - Street 1:9 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06778-2520
Practice Address - Country:US
Practice Address - Phone:860-484-4376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2007-07-09
Deactivation Date:2006-06-05
Deactivation Code:
Reactivation Date:2006-07-11
Provider Licenses
StateLicense IDTaxonomies
CT002882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP95480Medicare UPIN