Provider Demographics
NPI:1366902595
Name:FRITZ, BONNIE LOUISE (LPN)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LOUISE
Last Name:FRITZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 FRITZ RD
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-9120
Mailing Address - Country:US
Mailing Address - Phone:570-249-0565
Mailing Address - Fax:
Practice Address - Street 1:60 HORSESHOE DR
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-6216
Practice Address - Country:US
Practice Address - Phone:570-436-6491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN306655164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse