Healthcare Provider Details

I. General information

NPI: 1043231517
Provider Name (Legal Business Name): XIOMARA INEZ FRAY CHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 HARMON AVE SUITE 1D03
FORT STEWART GA
31314-5611
US

IV. Provider business mailing address

1061 HARMON AVE SUITE 1D03
FORT STEWART GA
31314-5611
US

V. Phone/Fax

Practice location:
  • Phone: 912-435-6933
  • Fax: 912-435-5966
Mailing address:
  • Phone: 912-435-6933
  • Fax: 912-435-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number344822
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: