Healthcare Provider Details

I. General information

NPI: 1821115858
Provider Name (Legal Business Name): THERESA M BECKER-FRITZ MS, RN, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 CROOKED ELM CT
DELAWARE OH
43015-8462
US

IV. Provider business mailing address

7652 SAWMILL RD PMB 160
DUBLIN OH
43016-9296
US

V. Phone/Fax

Practice location:
  • Phone: 740-881-6049
  • Fax: 740-881-6077
Mailing address:
  • Phone: 740-881-6049
  • Fax: 740-881-6077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.170378-COA1
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCOA03738-NS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: