Healthcare Provider Details

I. General information

NPI: 1417927138
Provider Name (Legal Business Name): KEVIN D FRITZ NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 S 6TH ST
BRAINERD MN
56401-4529
US

IV. Provider business mailing address

PO BOX 1450
MINNEAPOLIS MN
55485-7813
US

V. Phone/Fax

Practice location:
  • Phone: 218-828-7100
  • Fax:
Mailing address:
  • Phone: 701-364-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR113511-0
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP1528
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: