Healthcare Provider Details

I. General information

NPI: 1265770895
Provider Name (Legal Business Name): PATRICE NICOLE FRASER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 SAINT JOHNS AVE
YONKERS NY
10704-2902
US

IV. Provider business mailing address

60 SAINT JOHNS AVE
YONKERS NY
10704-2902
US

V. Phone/Fax

Practice location:
  • Phone: 347-423-0899
  • Fax:
Mailing address:
  • Phone: 347-423-0899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3376381
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number5802311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: