Provider Demographics
NPI:1982185328
Name:STASSI-FRITZ, MONICA ELLEN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ELLEN
Last Name:STASSI-FRITZ
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:ELLEN
Other - Last Name:STASSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4800 EXCELSIOR BLVD APT 222
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3051
Mailing Address - Country:US
Mailing Address - Phone:262-354-4087
Mailing Address - Fax:
Practice Address - Street 1:800 E 28TH ST STE H2100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12776363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical