Provider Demographics
NPI:1164966685
Name:FRITCH, REBECCA (CNM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FRITCH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SCHACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:513-853-4722
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:8TH FLOOR SETON CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-862-6200
Practice Address - Fax:513-862-4358
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH334486163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0230163Medicaid