Provider Demographics
NPI:1588097091
Name:FRASER, MEGAN (DNP, NP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:FRASER
Suffix:
Gender:F
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:TREACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, NP-C
Mailing Address - Street 1:909 FULTON ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-4800
Mailing Address - Country:US
Mailing Address - Phone:612-672-7422
Mailing Address - Fax:
Practice Address - Street 1:909 FULTON ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-4800
Practice Address - Country:US
Practice Address - Phone:612-672-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1627632163W00000X
COAPN.0991242-NP363LA2200X
MNR189990-6363LA2200X
MNCNP2736363LW0102X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health