Provider Demographics
NPI:1578581682
Name:FRITZ, LISA MARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:FRITZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 CURVE CREST BLVD W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5078
Mailing Address - Country:US
Mailing Address - Phone:651-430-3800
Mailing Address - Fax:651-430-1447
Practice Address - Street 1:1950 CURVE CREST BLVD W
Practice Address - Street 2:SUITE 100
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5078
Practice Address - Country:US
Practice Address - Phone:651-430-3800
Practice Address - Fax:651-430-1447
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8947363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN97000543Medicare ID - Type Unspecified
WI203050010Medicare PIN
WI491750010Medicare PIN
MN521117Medicare UPIN