Individual
LLOYREEN MOSS FRASER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MMP
Contact information
Practice address
813 DILIGENCE DR STE 121C, NEWPORT NEWS, VA 23606-4285
(757) 660-1796
Mailing address
813 DILIGENCE DR STE 121C, NEWPORT NEWS, VA 23606-4285
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0019009793
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019009793
STATE MASSAGE LICENSE NUMBER
VA
Enumeration date
10/13/2016
Last updated
04/25/2022
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