Provider Demographics
NPI:1033346200
Name:PRATZ, CAROLINE FIDYK (CRNP)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:FIDYK
Last Name:PRATZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N. BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMOE
Mailing Address - State:MD
Mailing Address - Zip Code:21231
Mailing Address - Country:US
Mailing Address - Phone:410-502-8010
Mailing Address - Fax:
Practice Address - Street 1:401 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:BALTIMOE
Practice Address - State:MD
Practice Address - Zip Code:21231
Practice Address - Country:US
Practice Address - Phone:410-502-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR149679363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419806900Medicaid
MD419806900Medicaid