Provider Demographics
NPI:1396487997
Name:FRASER, CASANDRA FAY
Entity type:Individual
Prefix:
First Name:CASANDRA
Middle Name:FAY
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 1:1400 W ELM ST APT 251400
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-4952
Mailing Address - Country:US
Mailing Address - Phone:405-549-3519
Mailing Address - Fax:
Practice Address - Street 1:100 RED MOON CIRCLE
Practice Address - Street 2:100 RED MOON CIRCLE
Practice Address - City:CONCHO
Practice Address - State:OK
Practice Address - Zip Code:73022
Practice Address - Country:US
Practice Address - Phone:405-422-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist