Provider Demographics
NPI:1720730617
Name:FRITZLER, BENJAMIN D (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:D
Last Name:FRITZLER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:DAVID
Other - Last Name:FRITZLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3900 STATE STREET RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2164
Mailing Address - Country:US
Mailing Address - Phone:989-391-4032
Mailing Address - Fax:
Practice Address - Street 1:3900 STATE STREET RD STE 110
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2164
Practice Address - Country:US
Practice Address - Phone:989-391-4032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704268203163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse