Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C53160 | AK |
NPI | 1760158141 |
---|---|
Provider Name | Jennifer Diane Fraiser |
First Address | Anchorage, AK 99508-4261 |
Second Address | Anchorage, AK 99508-4261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2021 |
Last Update Date | 17/08/2021 |