Provider Demographics
NPI:1942349600
Name:FRITZ, KIMBERLY JEAN (MOM, LAC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JEAN
Last Name:FRITZ
Suffix:
Gender:F
Credentials:MOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 125TH LN NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4957
Mailing Address - Country:US
Mailing Address - Phone:612-414-3250
Mailing Address - Fax:
Practice Address - Street 1:12203 ABERDEEN ST NE
Practice Address - Street 2:SUITE 120
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4719
Practice Address - Country:US
Practice Address - Phone:612-414-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1259171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist