Provider Demographics
NPI:1730651746
Name:FRASER-AITKENS, KERRI-ANN L (LPN)
Entity type:Individual
Prefix:MS
First Name:KERRI-ANN
Middle Name:L
Last Name:FRASER-AITKENS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GEORGE PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4815
Mailing Address - Country:US
Mailing Address - Phone:347-832-5795
Mailing Address - Fax:
Practice Address - Street 1:6 GEORGE PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4815
Practice Address - Country:US
Practice Address - Phone:347-832-5795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331009164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331009OtherNURSE LICENSE NUMBER