Provider Demographics
NPI:1760422091
Name:FRITZ, LILA BROOKS (RN, C-NM)
Entity Type:Individual
Prefix:
First Name:LILA
Middle Name:BROOKS
Last Name:FRITZ
Suffix:
Gender:F
Credentials:RN, C-NM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 E COUNTY ROAD 1800
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321-3102
Mailing Address - Country:US
Mailing Address - Phone:217-357-2250
Mailing Address - Fax:
Practice Address - Street 1:213 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:IL
Practice Address - Zip Code:62321-1419
Practice Address - Country:US
Practice Address - Phone:217-357-0617
Practice Address - Fax:217-357-0615
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
K06368Medicare ID - Type UnspecifiedGROUP NO. 208627
P43977Medicare UPIN
K18833Medicare ID - Type UnspecifiedGROUP NO. 211948
K04382Medicare ID - Type UnspecifiedGROUP NO. 208476