Provider Demographics
NPI:1457736936
Name:FRASER, LINDEN (RN)
Entity type:Individual
Prefix:
First Name:LINDEN
Middle Name:
Last Name:FRASER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 LEATZOW RD
Mailing Address - Street 2:
Mailing Address - City:THREE LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:54562-9754
Mailing Address - Country:US
Mailing Address - Phone:715-360-1304
Mailing Address - Fax:
Practice Address - Street 1:849 LEATZOW RD
Practice Address - Street 2:
Practice Address - City:THREE LAKES
Practice Address - State:WI
Practice Address - Zip Code:54562-9754
Practice Address - Country:US
Practice Address - Phone:715-360-1304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128217163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse