Provider Demographics
NPI:1023760295
Name:LAFRITZ, TINA MICHELLE
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MICHELLE
Last Name:LAFRITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 ROARING RUN RD
Mailing Address - Street 2:
Mailing Address - City:GILLETT
Mailing Address - State:PA
Mailing Address - Zip Code:16925-9691
Mailing Address - Country:US
Mailing Address - Phone:607-426-4557
Mailing Address - Fax:
Practice Address - Street 1:4703 ROARING RUN RD
Practice Address - Street 2:
Practice Address - City:GILLETT
Practice Address - State:PA
Practice Address - Zip Code:16925-9691
Practice Address - Country:US
Practice Address - Phone:607-426-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information