Provider Demographics
NPI:1104918234
Name:FRAZER, VIRGINIA LAING (ND, LM)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:LAING
Last Name:FRAZER
Suffix:
Gender:F
Credentials:ND, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3928
Mailing Address - Country:US
Mailing Address - Phone:509-586-9691
Mailing Address - Fax:509-582-3661
Practice Address - Street 1:315 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3928
Practice Address - Country:US
Practice Address - Phone:509-586-9691
Practice Address - Fax:509-582-3661
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA252-05-677175F00000X
WA252-13-160176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA252-05-677OtherND LICENSE NUMBER
WA252-13-160OtherLM LICENSE NUMBER
WA252-05-677OtherND LICENSE NUMBER