Healthcare Provider Details

I. General information

NPI: 1770307977
Provider Name (Legal Business Name): EVELYN MARIE FRITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12811 Q ST
OMAHA NE
68137-3211
US

IV. Provider business mailing address

12811 Q ST
OMAHA NE
68137-3211
US

V. Phone/Fax

Practice location:
  • Phone: 402-230-5861
  • Fax: 531-200-5808
Mailing address:
  • Phone: 402-230-5861
  • Fax: 531-200-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-473545
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: