Provider Demographics
NPI:1104848571
Name:FRANTZ, MARY CATHERINE (RN,MS,CS,CACIII)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:FRANTZ
Suffix:
Gender:F
Credentials:RN,MS,CS,CACIII
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:FRANTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3211 W 20TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6566
Mailing Address - Country:US
Mailing Address - Phone:970-353-2000
Mailing Address - Fax:970-356-4827
Practice Address - Street 1:3211 W 20TH ST STE D
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6566
Practice Address - Country:US
Practice Address - Phone:970-353-2000
Practice Address - Fax:970-356-4827
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78098364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07780984Medicaid
CO262218OtherVALUE OPTIONS PROVIDER NO
CO643342OtherBLUE CROSS PROVIDER NO
CO07780984Medicaid