Provider Demographics
NPI:1972179091
Name:FRASIER, ALICIA L
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:L
Last Name:FRASIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:FRASIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ALICIA FRASIER LPN
Mailing Address - Street 1:380 NORTHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14208-1337
Mailing Address - Country:US
Mailing Address - Phone:716-868-5584
Mailing Address - Fax:
Practice Address - Street 1:18 BARBARA PL
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14225-2829
Practice Address - Country:US
Practice Address - Phone:716-868-5584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-30
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339521164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse