Provider Demographics
NPI:1124783741
Name:FRASER, MISHARO C (ND)
Entity type:Individual
Prefix:DR
First Name:MISHARO
Middle Name:C
Last Name:FRASER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WEDGEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1927
Mailing Address - Country:US
Mailing Address - Phone:203-526-5332
Mailing Address - Fax:
Practice Address - Street 1:75 WEDGEWOOD PL
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1927
Practice Address - Country:US
Practice Address - Phone:203-526-5332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT695175F00000X
NH0054175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath