Provider Demographics
NPI:1629754379
Name:FRITSON, MICHAELA MARIE
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:MARIE
Last Name:FRITSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:MARIE
Other - Last Name:MASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14205 CEDAR CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2121
Mailing Address - Country:US
Mailing Address - Phone:402-690-4026
Mailing Address - Fax:
Practice Address - Street 1:14205 CEDAR CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2121
Practice Address - Country:US
Practice Address - Phone:402-690-4026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program