Provider Demographics
NPI:1194133918
Name:FRASER, IANA GABRIELA (RN)
Entity type:Individual
Prefix:MS
First Name:IANA
Middle Name:GABRIELA
Last Name:FRASER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:IANA
Other - Middle Name:GABRIELA
Other - Last Name:FRASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:300 LAKE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5295
Mailing Address - Country:US
Mailing Address - Phone:802-373-1636
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5259
Practice Address - Country:US
Practice Address - Phone:802-373-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
VT026.0146755163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist