Provider Demographics
NPI:1710053715
Name:FRITZ, BONNIE MARIE (RD)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:MARIE
Last Name:FRITZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14135 56TH AVE S
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-4506
Mailing Address - Country:US
Mailing Address - Phone:206-444-6168
Mailing Address - Fax:
Practice Address - Street 1:1916 BOREN AVE
Practice Address - Street 2:STE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1467
Practice Address - Country:US
Practice Address - Phone:206-296-2755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001188133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8263014Medicaid