Provider Demographics
NPI:1598374084
Name:FRITZ, FREDERICK L (PMHNP)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:L
Last Name:FRITZ
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9870 LINCOLNSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-5236
Mailing Address - Country:US
Mailing Address - Phone:937-829-8650
Mailing Address - Fax:
Practice Address - Street 1:9870 LINCOLNSHIRE RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-5236
Practice Address - Country:US
Practice Address - Phone:937-829-8650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0027151363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health