Healthcare Provider Details

I. General information

NPI: 1194133918
Provider Name (Legal Business Name): IANA GABRIELA FRASER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IANA GABRIELA FRASER RN

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST STE 208
BURLINGTON VT
05401-5259
US

IV. Provider business mailing address

300 LAKE ST APT 202
BURLINGTON VT
05401-5295
US

V. Phone/Fax

Practice location:
  • Phone: 802-373-1636
  • Fax:
Mailing address:
  • Phone: 802-373-1636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number026.0146755
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: