Provider Demographics
NPI:1871235119
Name:FRITZ, DONIKA LASHUN
Entity Type:Individual
Prefix:
First Name:DONIKA
Middle Name:LASHUN
Last Name:FRITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:419-685-8010
Mailing Address - Fax:419-932-6232
Practice Address - Street 1:2555 S DIXIE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1539
Practice Address - Country:US
Practice Address - Phone:937-853-9061
Practice Address - Fax:937-853-9069
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2615030Medicaid