Healthcare Provider Details

I. General information

NPI: 1144581034
Provider Name (Legal Business Name): MARCY FRITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 CIRCLE DR
ABERDEEN SD
57401-2615
US

IV. Provider business mailing address

703 3RD AVE SE
ABERDEEN SD
57401-4508
US

V. Phone/Fax

Practice location:
  • Phone: 605-225-1010
  • Fax: 605-225-1017
Mailing address:
  • Phone: 605-225-1010
  • Fax: 605-225-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR015444
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: