Provider Demographics
NPI:1336848183
Name:FRITZ, SHELLY D
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:D
Last Name:FRITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:D
Other - Last Name:HYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 N INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-4097
Mailing Address - Country:US
Mailing Address - Phone:580-634-3317
Mailing Address - Fax:
Practice Address - Street 1:302 N INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4097
Practice Address - Country:US
Practice Address - Phone:580-634-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator