Provider Demographics
NPI:1770545261
Name:FRITCH, LISA (APRN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FRITCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3060
Mailing Address - Country:US
Mailing Address - Phone:860-242-8756
Mailing Address - Fax:
Practice Address - Street 1:711 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3060
Practice Address - Country:US
Practice Address - Phone:860-242-8756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004238730Medicaid
CTP00070510OtherRAILROAD MEDICARE
500001113Medicare ID - Type Unspecified
P98033Medicare UPIN