Healthcare Provider Details

I. General information

NPI: 1891049490
Provider Name (Legal Business Name): VELMA ASNETH FRASIER MSN,RN,APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2012
Last Update Date: 11/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 BROADWAY
WEST NEW YORK NJ
07093-2622
US

IV. Provider business mailing address

5301 BROADWAY
WEST NEW YORK NJ
07093-2622
US

V. Phone/Fax

Practice location:
  • Phone: 201-866-9320
  • Fax:
Mailing address:
  • Phone: 201-866-9320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00400600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: