Provider Demographics
NPI:1235395534
Name:FRITSCH, GLORIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:FRITSCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:HOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:702 BARNHILL DR
Practice Address - Street 2:SUITE 1134
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5128
Practice Address - Country:US
Practice Address - Phone:317-274-8852
Practice Address - Fax:317-274-8895
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002696A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200986510Medicaid
IN000000641124OtherANTHEM BLUE CROSS AND BLUE SHIELD
IN200986510Medicaid