Provider Demographics
NPI:1568474617
Name:FRITZ, LESLIE J (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:J
Last Name:FRITZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:J
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:215-955-5000
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4414
Practice Address - Country:US
Practice Address - Phone:215-955-5000
Practice Address - Fax:215-503-0523
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009410174400000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102885774Medicaid
PA314463Medicare PIN