Provider Demographics
NPI:1801566815
Name:FRAISER, LATIFA
Entity type:Individual
Prefix:
First Name:LATIFA
Middle Name:
Last Name:FRAISER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 DUNNEMANN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-3632
Mailing Address - Country:US
Mailing Address - Phone:843-367-3030
Mailing Address - Fax:
Practice Address - Street 1:37 DUNNEMANN AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-3632
Practice Address - Country:US
Practice Address - Phone:843-367-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide