Provider Demographics
NPI:1841641941
Name:FRITZ, CASSONDRA GWEN (CRNA)
Entity type:Individual
Prefix:MISS
First Name:CASSONDRA
Middle Name:GWEN
Last Name:FRITZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6565 AGATE TRL
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55077-4720
Mailing Address - Country:US
Mailing Address - Phone:605-949-1711
Mailing Address - Fax:
Practice Address - Street 1:6401 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2104
Practice Address - Country:US
Practice Address - Phone:651-917-1425
Practice Address - Fax:612-672-4123
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1968367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered