Provider Demographics
NPI:1740748862
Name:FRITZ, AMY JO (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JO
Last Name:FRITZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 LOVERS LN STE 3
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1673
Mailing Address - Country:US
Mailing Address - Phone:269-381-6950
Mailing Address - Fax:
Practice Address - Street 1:5930 LOVERS LN STE 3
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1673
Practice Address - Country:US
Practice Address - Phone:269-381-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704269941363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health