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General NPI Number Information
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NPI Number | 1083228829
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Entity Type | Individual
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Provider Name | EDITH A FRAIRE MSN, RN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 2824 ELKHART RD
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City | GOSHEN
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State | IN
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Zip | 46526-1014
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Country | US
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Telephone | 574-535-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 3421 S MAIN ST
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City | ELKHART
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State | IN
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Zip | 46517-3125
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Country | US
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Telephone | 574-295-7178
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Fax | 574-295-8822
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71010425A
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License Number State | IN
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