Provider Demographics
NPI: | 1922241330 |
---|---|
Name: | FOSTER-FRITSCH, THERESA ANN (RN) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | THERESA |
Middle Name: | ANN |
Last Name: | FOSTER-FRITSCH |
Suffix: | |
Gender: | F |
Credentials: | RN |
Other - Prefix: | |
Other - First Name: | THERRI |
Other - Middle Name: | |
Other - Last Name: | FOSTER-FRITSCH |
Other - Suffix: | |
Other - Last Name Type: | Professional Name |
Other - Credentials: | RN |
Mailing Address - Street 1: | 7249 CLOVERNOOK AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | CINCINNATI |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45231-5520 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-582-2249 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7249 CLOVERNOOK AVE |
Practice Address - Street 2: | |
Practice Address - City: | CINCINNATI |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45231-5520 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-582-2249 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2009-04-15 |
Last Update Date: | 2011-05-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 287595 | 163W00000X |
GA | RN191113 | 163WH0200X |
175L00000X, 175F00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health |
No | 175L00000X | Other Service Providers | Homeopath | |
No | 175F00000X | Other Service Providers | Naturopath |