Healthcare Provider Details

I. General information

NPI: 1295934818
Provider Name (Legal Business Name): AMANDA FRASER L.M.T.,R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

4997 BUTTE PL NW
ALBUQUERQUE NM
87120-4410
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1977
  • Fax:
Mailing address:
  • Phone: 505-999-6243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4045
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN70412
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: