Healthcare Provider Details

I. General information

NPI: 1780632521
Provider Name (Legal Business Name): JANE K. FRASER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 SUPERIOR ST
ROSSFORD OH
43460-1246
US

IV. Provider business mailing address

2200 JEFFERSON AVE 4TH FLOOR
TOLEDO OH
43624-1120
US

V. Phone/Fax

Practice location:
  • Phone: 419-666-5202
  • Fax: 419-666-7081
Mailing address:
  • Phone: 419-251-2673
  • Fax: 419-251-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP03034
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: