Provider Demographics
NPI:1558321794
Name:FRANTZICH, CARRIE JAYNE ROTH (CNM)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:JAYNE ROTH
Last Name:FRANTZICH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11575 PALISADE AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-3409
Mailing Address - Country:US
Mailing Address - Phone:651-351-5431
Mailing Address - Fax:
Practice Address - Street 1:1875 WOODWINDS DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2298
Practice Address - Country:US
Practice Address - Phone:651-232-6700
Practice Address - Fax:651-232-6711
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR123364-3176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife