Provider Demographics
NPI:1912386087
Name:FRAYSER, MARY FIMIAN (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FIMIAN
Last Name:FRAYSER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1125
Mailing Address - Country:US
Mailing Address - Phone:804-798-8307
Mailing Address - Fax:804-798-4204
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-1125
Practice Address - Country:US
Practice Address - Phone:804-798-8307
Practice Address - Fax:804-798-4204
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05733Medicare PIN