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General NPI Number Information
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NPI Number | 1982905683
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Entity Type | Individual
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Provider Name | IDA LEE FRASER CNP
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Gender | Female
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 2402 W PIERCE ST SUITE 4A
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City | CARLSBAD
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State | NM
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Zip | 88220-3537
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Country | US
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Telephone | 575-234-9964
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Fax | 575-234-3438
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Provider Business Mailing Address
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Address Line | 2402 W PIERCE ST SUITE A
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City | CARLSBAD
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State | NM
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Zip | 88220-3537
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Country | US
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Telephone | 575-234-9964
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Fax | 575-234-3438
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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 | CNP 01698
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License Number State | NM
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