| Doctor Name: | MRS. SUSAN MARIE FRAGO |
| NPI Number: | 1366885667 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 2013017936 |
| Business Practice Address: | 114 Downey Pl Cuba, MO - 654531640 |
| Business Phone Number: | 5738853358 |
| Business Fax Number: | |
| Mailing Address: | Po Box 2580, SPRINGFIELD |
| State: | MO |
| Postal Code: | 658012580 |
| Phone Number: | 4178294620 |
| Fax Number: | |
| NPI Enumeration Date: | 04/17/2013 |
| NPI Last Update Date: | 02/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2013017936 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |