Provider Demographics
NPI:1821115858
Name:BECKER-FRITZ, THERESA M (MS, RN, CS)
Entity Type:Individual
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First Name:THERESA
Middle Name:M
Last Name:BECKER-FRITZ
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Gender:F
Credentials:MS, RN, CS
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Mailing Address - Street 1:7652 SAWMILL RD
Mailing Address - Street 2:PMB 160
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9296
Mailing Address - Country:US
Mailing Address - Phone:740-881-6049
Mailing Address - Fax:740-881-6077
Practice Address - Street 1:6480 CROOKED ELM CT
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-8462
Practice Address - Country:US
Practice Address - Phone:740-881-6049
Practice Address - Fax:740-881-6077
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2011-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN.170378-COA1163W00000X
OHCOA03738-NS364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114017-02OtherCLINICAL SPECIALIST