Healthcare Provider Details

I. General information

NPI: 1487686978
Provider Name (Legal Business Name): STEPHANIE FRITZ LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/24/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 W WHITE CLIFFS DRIVE
ORDERVILLE UT
84758
US

IV. Provider business mailing address

PO BOX 5581
MOUNT CARMEL UT
84755-5581
US

V. Phone/Fax

Practice location:
  • Phone: 520-266-0738
  • Fax:
Mailing address:
  • Phone: 520-266-0738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number130
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: