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General NPI Number Information
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NPI Number | 1528544558
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Entity Type | Individual
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Provider Name | HALLIE MARIE FRASER
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Gender | Female
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 5111 AUTO CLUB DR STE 112B
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City | DEARBORN
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State | MI
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Zip | 48126-2684
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Country | US
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Telephone | 248-536-5085
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Fax | 248-475-6403
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Provider Business Mailing Address
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Address Line | 15679 CHURCHILL ST
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City | SOUTHGATE
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State | MI
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Zip | 48195-3290
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Country | US
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Telephone | 734-624-2951
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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