Basic Information
| Provider Information | |||||||||
| NPI: | 1700506227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRASER | ||||||||
| FirstName: | MORRISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| OtherOrganizationType: | |||||||||
| OtherLastName: | FRASER | ||||||||
| OtherFirstName: | MORRISA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | MAIL STOP C271 | ||||||||
| Address2: | 12348 E. MONTVIEW BLVD | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037249030 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12348 E MONTVIEW BLD MS C271 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037249030 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2022 | ||||||||
| LastUpdateDate: | 09/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174V00000X | 6000577 | CO | Y | Other Service Providers | Clinical Ethicist |
ID Information
| ID | Type | State | Issuer | Description | 162590841 | 01 | CO | DRIVERS LICENSE | OTHER |