Provider Demographics
NPI:1205090008
Name:FRASER, YVONNE ISABELLE
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:ISABELLE
Last Name:FRASER
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 1:100 DREISER LOOP
Mailing Address - Street 2:APT. 15A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 DREISER LOOP
Practice Address - Street 2:APT. 15A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2632
Practice Address - Country:US
Practice Address - Phone:718-671-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228103-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse