Healthcare Provider Details

I. General information

NPI: 1184802803
Provider Name (Legal Business Name): LINDA JO FRASIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S UNION BLVD
COLO SPGS CO
80910-3123
US

IV. Provider business mailing address

301 S UNION BLVD
COLO SPGS CO
80910-3123
US

V. Phone/Fax

Practice location:
  • Phone: 719-578-3237
  • Fax:
Mailing address:
  • Phone: 719-578-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number82868
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: