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General NPI Number Information
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NPI Number | 1174288815
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Entity Type | Individual
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Provider Name | KATIE LANGE FRITZ
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Gender | Female
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 700 COOPER AVE
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City | SAGINAW
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State | MI
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Zip | 48602-5383
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Country | US
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Telephone | 989-583-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 5934 BAYBERRY FARMS DR SW APT 6
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City | WYOMING
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State | MI
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Zip | 49418-9219
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Country | US
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Telephone | 989-737-6595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704288508
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License Number State | MI
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