Provider Demographics
NPI:1427743202
Name:FRASER, PATRICE ANN (CERTIFICATION)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:ANN
Last Name:FRASER
Suffix:
Gender:F
Credentials:CERTIFICATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 ECHO LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3569
Mailing Address - Country:US
Mailing Address - Phone:561-632-8660
Mailing Address - Fax:561-844-9760
Practice Address - Street 1:1900 ECHO LAKE DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3569
Practice Address - Country:US
Practice Address - Phone:561-632-8660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
DC3747P1801X
VA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant