Provider Demographics
NPI:1518222322
Name:FRITZ, NANCY R (RN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:FRITZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23044 JENSEN CT
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5570
Mailing Address - Country:US
Mailing Address - Phone:909-533-4056
Mailing Address - Fax:909-533-4056
Practice Address - Street 1:23044 JENSEN CT
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5570
Practice Address - Country:US
Practice Address - Phone:909-533-4056
Practice Address - Fax:909-533-4056
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-08
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301177163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACAMedicaid