Provider Demographics
NPI:1881785483
Name:FRASIEUR, AMY MAE (MS RDN LD)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:MAE
Last Name:FRASIEUR
Suffix:
Gender:F
Credentials:MS RDN LD
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:MAE
Other - Last Name:LORINCZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:108 SW MEMORIAL PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-8667
Mailing Address - Country:US
Mailing Address - Phone:541-737-5041
Mailing Address - Fax:
Practice Address - Street 1:108 SW MEMORIAL PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8667
Practice Address - Country:US
Practice Address - Phone:541-737-5041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
R120111Medicare UPIN
Q20588Medicare UPIN