MEDICARE: SIMONE FRASER LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	270430	NY

General Provider Information

NPI Number	:	1821327842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMONE FRASER LPN

Provider Business Mailing Address
First Line	:	545 MANHATTAN AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-5215
Country	:	US
Telephone Number	:	212-222-5221
Fax Number	:	212-531-7514

Provider Business Practice Location Address
First Line	:	545 MANHATTAN AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-5215
Country	:	US
Telephone Number	:	212-222-5221
Fax Number	:	212-531-7514

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2009
Last Update Date	:	12/22/2009

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