Healthcare Provider Details

I. General information

NPI: 1992785265
Provider Name (Legal Business Name): JENNIFER AMY FRITZ-MILLARD ARNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MS. JENNIFER AMY FRITZ

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19110 BOTHELL WAY NE SUITE 206
BOTHELL WA
98011-2970
US

IV. Provider business mailing address

12023 14TH DR SE
EVERETT WA
98208-5916
US

V. Phone/Fax

Practice location:
  • Phone: 425-806-8360
  • Fax: 425-806-9475
Mailing address:
  • Phone: 425-379-9241
  • Fax: 425-806-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30007236
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: